Provider Demographics
NPI:1821152422
Name:KYUHO LIM DMD, PC
Entity Type:Organization
Organization Name:KYUHO LIM DMD, PC
Other - Org Name:KENDALL SQUARE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYUHO
Authorized Official - Middle Name:
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-577-8700
Mailing Address - Street 1:1 BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-3869
Mailing Address - Country:US
Mailing Address - Phone:781-729-1224
Mailing Address - Fax:
Practice Address - Street 1:1 KENDALL SQ
Practice Address - Street 2:BUILDING 300, SUITE 312
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1562
Practice Address - Country:US
Practice Address - Phone:617-577-8700
Practice Address - Fax:617-577-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA143261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX10929KEOtherBCBS OF MASS
MA04614OtherDELTA DENTAL OF MASS