Provider Demographics
NPI:1497951750
Name:GEORGE D. LIM DMD INC-HOLLYWOOD
Entity Type:Organization
Organization Name:GEORGE D. LIM DMD INC-HOLLYWOOD
Other - Org Name:GEORGE D LIM DMD INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DIG
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-953-0505
Mailing Address - Street 1:1551 N VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5330
Mailing Address - Country:US
Mailing Address - Phone:323-953-0505
Mailing Address - Fax:
Practice Address - Street 1:1551 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5330
Practice Address - Country:US
Practice Address - Phone:323-953-0505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE D. LIM, DMD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-25
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92264-03OtherDENTI-CAL PROVIDER NUMBER
CA343190OtherDELTA DENTAL OF CA