Provider Demographics
NPI:1518245604
Name:LIM, ELLA TIN AYE KHINE (DDS)
Entity type:Individual
Prefix:DR
First Name:ELLA
Middle Name:TIN AYE KHINE
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 1:1503 DEBBI CT
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-6609
Mailing Address - Country:US
Mailing Address - Phone:858-200-6631
Mailing Address - Fax:
Practice Address - Street 1:29 ROTARY WAY
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-8475
Practice Address - Country:US
Practice Address - Phone:707-554-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-24
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038804122300000X
CA62040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist