Provider Demographics
NPI:1659738904
Name:CHING LAN LIM, DMD INC
Entity Type:Organization
Organization Name:CHING LAN LIM, DMD INC
Other - Org Name:NORTH BAKERSFIELD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHING LAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-399-1058
Mailing Address - Street 1:215 CHINA GRADE LOOP
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-1707
Mailing Address - Country:US
Mailing Address - Phone:661-399-1058
Mailing Address - Fax:661-399-5062
Practice Address - Street 1:215 CHINA GRADE LOOP
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-1707
Practice Address - Country:US
Practice Address - Phone:661-399-1058
Practice Address - Fax:661-399-5062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57620122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty