Provider Demographics
NPI:1972651073
Name:LIM, GLADYS H (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLADYS
Middle Name:H
Last Name:LIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 66TH ST.
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1133
Mailing Address - Country:US
Mailing Address - Phone:510-985-0780
Mailing Address - Fax:
Practice Address - Street 1:160 WAVERLY PL
Practice Address - Street 2:302
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1603
Practice Address - Country:US
Practice Address - Phone:415-399-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist