Provider Demographics
NPI:1629282934
Name:LIM, SUE KYUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUE
Middle Name:KYUNG
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 1:5116 196TH ST SW
Mailing Address - Street 2:STE 201
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6148
Mailing Address - Country:US
Mailing Address - Phone:425-771-0165
Mailing Address - Fax:425-670-1185
Practice Address - Street 1:5116 196TH ST SW
Practice Address - Street 2:STE 201
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6148
Practice Address - Country:US
Practice Address - Phone:425-771-0165
Practice Address - Fax:425-670-1185
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist