Provider Demographics
NPI:1508343120
Name:LIM, JI HYUN
Entity Type:Individual
Prefix:
First Name:JI HYUN
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 2ND AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8206
Mailing Address - Country:US
Mailing Address - Phone:917-873-3239
Mailing Address - Fax:
Practice Address - Street 1:77 QUAKER RIDGE RD STE 206
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10804-2821
Practice Address - Country:US
Practice Address - Phone:914-301-6305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04436122300000X
NY2569294122300000X
NJ22DI02831000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist