Provider Demographics
NPI:1750502373
Name:HUANG, LISA LIM (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LIM
Last Name:HUANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1700 ADAMS AVENUE
Mailing Address - Street 2:SIUTE 104
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-545-0429
Mailing Address - Fax:714-545-0408
Practice Address - Street 1:1700 ADAMS AVENUE SUITE 104
Practice Address - Street 2:SIUTE 104
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:714-545-0429
Practice Address - Fax:714-545-0408
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA394151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice