Provider Demographics
NPI:1558455998
Name:GEORGE D. LIM, DMD, INC.
Entity type:Organization
Organization Name:GEORGE D. LIM, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-391-7173
Mailing Address - Street 1:11725 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5917
Mailing Address - Country:US
Mailing Address - Phone:310-391-7173
Mailing Address - Fax:310-391-7166
Practice Address - Street 1:11725 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5917
Practice Address - Country:US
Practice Address - Phone:310-391-7173
Practice Address - Fax:310-391-7166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE D. LIM, DMD, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty