Provider Demographics
NPI:1467930180
Name:LIM, JULIA Y (DDS)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:Y
Last Name:LIM
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 1:13446 REVA CIR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8920
Mailing Address - Country:US
Mailing Address - Phone:213-820-8002
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7394
Practice Address - Country:US
Practice Address - Phone:213-820-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2022-05-12
Deactivation Date:2019-03-28
Deactivation Code:
Reactivation Date:2019-04-12
Provider Licenses
StateLicense IDTaxonomies
CA102288122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist