Provider Demographics
NPI:1578783916
Name:LIM, JOHN SANCHO (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SANCHO
Last Name:LIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:10120 ALONDRA BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-3904
Mailing Address - Country:US
Mailing Address - Phone:562-920-6644
Mailing Address - Fax:562-920-6634
Practice Address - Street 1:10120 ALONDRA BLVD
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3904
Practice Address - Country:US
Practice Address - Phone:562-920-6644
Practice Address - Fax:562-920-6634
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB38319-01Medicare ID - Type UnspecifiedDENTICAL #