Provider Demographics
NPI:1801976188
Name:LIM, JONGCHUL (DDS)
Entity type:Individual
Prefix:DR
First Name:JONGCHUL
Middle Name:
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 1:14236 38TH AVE APT BA
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5532
Mailing Address - Country:US
Mailing Address - Phone:718-886-8485
Mailing Address - Fax:
Practice Address - Street 1:14236 38TH AVE APT BA
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5532
Practice Address - Country:US
Practice Address - Phone:718-886-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist