Provider Demographics
NPI:1659820637
Name:BAE LIM DENTAL CORPORATION
Entity Type:Organization
Organization Name:BAE LIM DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-251-1059
Mailing Address - Street 1:3631 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-2007
Mailing Address - Country:US
Mailing Address - Phone:310-386-1799
Mailing Address - Fax:
Practice Address - Street 1:3631 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2007
Practice Address - Country:US
Practice Address - Phone:310-386-1799
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAE LIM DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-01
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275833204Medicaid
CA1982772240Medicaid