Provider Demographics
NPI:1205276185
Name:LIM, JINSEUP (DMD)
Entity type:Individual
Prefix:DR
First Name:JINSEUP
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 WEST HIGHWAY 105
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132
Mailing Address - Country:US
Mailing Address - Phone:192-984-9907
Mailing Address - Fax:192-984-9907
Practice Address - Street 1:556 WEST HIGHWAY 105
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132
Practice Address - Country:US
Practice Address - Phone:192-984-9907
Practice Address - Fax:192-984-9907
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN202061223S0112X
CO002035771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery