Provider Demographics
NPI:1467086033
Name:CHA, ROSALYN LIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSALYN
Middle Name:LIM
Last Name:CHA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 LA GRACIA CIR UNIT 215
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-1926
Mailing Address - Country:US
Mailing Address - Phone:408-505-2355
Mailing Address - Fax:
Practice Address - Street 1:3221 S HIGUERA ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-6924
Practice Address - Country:US
Practice Address - Phone:805-544-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-23
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18587051223G0001X
CA108139122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice