Provider Demographics
NPI:1720144082
Name:LIM, ALBERT WHASIK (DDS)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:WHASIK
Last Name:LIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 N VERMONT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1748
Mailing Address - Country:US
Mailing Address - Phone:323-666-7562
Mailing Address - Fax:323-666-7564
Practice Address - Street 1:1211 N VERMONT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1748
Practice Address - Country:US
Practice Address - Phone:323-666-7562
Practice Address - Fax:323-666-7564
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice