Provider Demographics
NPI:1659886851
Name:LIM, MICHELE JOOHEE (DE)
Entity Type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:JOOHEE
Last Name:LIM
Suffix:
Gender:F
Credentials:DE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 4TH AVE APT 413
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1882
Mailing Address - Country:US
Mailing Address - Phone:614-381-5191
Mailing Address - Fax:
Practice Address - Street 1:2720 4TH AVE APT 413
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-1882
Practice Address - Country:US
Practice Address - Phone:614-381-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-10
Last Update Date:2017-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60806282122300000X
WADE60806282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist