MEDICARE: RISKA K. LIM DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	50982	CA

General Provider Information

NPI Number	:	1164793899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISKA K. LIM DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1241 S SOTO ST
Second Line	:	SUITE # 117
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2652
Country	:	US
Telephone Number	:	323-264-2410
Fax Number	:	323-264-2241

Provider Business Practice Location Address
First Line	:	1241 S SOTO ST
Second Line	:	SUITE # 117
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2652
Country	:	US
Telephone Number	:	323-264-2410
Fax Number	:	323-264-2241

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. RISKA K LIM
Credential	:	D.D.S
Telephone Number	:	323-264-2410

Provider Enumeration Date	:	01/26/2012
Last Update Date	:	05/16/2014

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