Provider Demographics
NPI:1073045027
Name:LIM, DONGKOOK DENNIS (DDS)
Entity type:Individual
Prefix:DR
First Name:DONGKOOK
Middle Name:DENNIS
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 1:13120 NE 112TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-4102
Mailing Address - Country:US
Mailing Address - Phone:626-940-7769
Mailing Address - Fax:
Practice Address - Street 1:19106 33RD AVE W STE 1
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4712
Practice Address - Country:US
Practice Address - Phone:425-775-5411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS101029122300000X
WADE608826891223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist