Provider Demographics
NPI:1023425824
Name:LIM, KAMILE JUREVICIUTE
Entity type:Individual
Prefix:DR
First Name:KAMILE
Middle Name:JUREVICIUTE
Last Name:LIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 MURRIETA BLVD #101
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-6002
Mailing Address - Country:US
Mailing Address - Phone:925-455-9510
Mailing Address - Fax:
Practice Address - Street 1:1171 MURRIETA BLVD #101
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6002
Practice Address - Country:US
Practice Address - Phone:925-455-9510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-14
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63618122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist