Provider Demographics
NPI:1285805317
Name:LIM, JIIN (DDS)
Entity type:Individual
Prefix:DR
First Name:JIIN
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 BLAKE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5226
Mailing Address - Country:US
Mailing Address - Phone:805-494-6462
Mailing Address - Fax:
Practice Address - Street 1:372 BLAKE RIDGE CT
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-5226
Practice Address - Country:US
Practice Address - Phone:805-494-6462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA479361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice