Provider Demographics
NPI:1518183599
Name:LIM, RISKA K (DDS)
Entity Type:Individual
Prefix:DR
First Name:RISKA
Middle Name:K
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 1:2228 HITCHCOCK DR
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-4505
Mailing Address - Country:US
Mailing Address - Phone:626-823-3884
Mailing Address - Fax:
Practice Address - Street 1:1241 S SOTO ST
Practice Address - Street 2:117
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2652
Practice Address - Country:US
Practice Address - Phone:323-264-2410
Practice Address - Fax:323-264-2241
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371291223G0001X
IL19-0217471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice