Provider Demographics
NPI:1851791131
Name:LIM, DOO YONG (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOO YONG
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 SANTA ELENA CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-7913
Mailing Address - Country:US
Mailing Address - Phone:909-354-1986
Mailing Address - Fax:
Practice Address - Street 1:2200 S MOUNTAIN AVE STE C
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-6717
Practice Address - Country:US
Practice Address - Phone:909-391-8801
Practice Address - Fax:909-391-8803
Is Sole Proprietor?:No
Enumeration Date:2014-08-24
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA639601223G0001X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice