Provider Demographics
NPI:1497146872
Name:RICHARD S. LIM, DDS, INC.
Entity Type:Organization
Organization Name:RICHARD S. LIM, DDS, INC.
Other - Org Name:YUCAIPA FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-797-8090
Mailing Address - Street 1:11834 BRYANT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-3848
Mailing Address - Country:US
Mailing Address - Phone:909-797-8090
Mailing Address - Fax:909-918-0595
Practice Address - Street 1:11834 BRYANT ST STE 102
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-3848
Practice Address - Country:US
Practice Address - Phone:909-797-8090
Practice Address - Fax:909-918-0595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62480122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1962842575Medicaid