Provider Demographics
NPI:1952513103
Name:ANDREW J. LIM, DDS, INC.
Entity Type:Organization
Organization Name:ANDREW J. LIM, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JUHWAN
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-947-7777
Mailing Address - Street 1:15550 MAIN ST STE B7
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3491
Mailing Address - Country:US
Mailing Address - Phone:760-947-7777
Mailing Address - Fax:760-947-1331
Practice Address - Street 1:15550 MAIN ST STE B7
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3491
Practice Address - Country:US
Practice Address - Phone:609-477-7777
Practice Address - Fax:760-947-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty