Provider Demographics
NPI:1508918871
Name:LIM, HYO J (DMD)
Entity Type:Individual
Prefix:DR
First Name:HYO
Middle Name:J
Last Name:LIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:216 MALL BLVD
Mailing Address - Street 2:SUITE #11
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-2923
Mailing Address - Country:US
Mailing Address - Phone:610-265-4485
Mailing Address - Fax:610-265-4486
Practice Address - Street 1:216 MALL BLVD
Practice Address - Street 2:SUITE #11
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-2923
Practice Address - Country:US
Practice Address - Phone:610-265-4485
Practice Address - Fax:610-265-4486
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS031106L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice