Provider Demographics
NPI:1700269172
Name:LIM, YOUNG SIK (DDS)
Entity Type:Individual
Prefix:
First Name:YOUNG SIK
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:YOUNGSIK
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:26203 MISSION RD
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-6543
Mailing Address - Country:US
Mailing Address - Phone:817-915-7753
Mailing Address - Fax:
Practice Address - Street 1:26203 MISSION RD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-6543
Practice Address - Country:US
Practice Address - Phone:817-915-7753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-03
Last Update Date:2015-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64657122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist