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NPI Code Detail

MEDICARE: GEORGE D. LIM DMD INC-HOLLYWOOD

MEDICARE: GEORGE D. LIM DMD INC-HOLLYWOOD
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
11223G0001XGeneral Practice Dentistry43190CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G92264-03OTHERCADENTI-CAL PROVIDER NUMBER
2343190OTHERCADELTA DENTAL OF CA

General Provider Information

NPI Number : 1497951750
Entity Type Code : Organization
Provider Name (Legal Business Name) : GEORGE D. LIM DMD INC-HOLLYWOOD
Provider Business Mailing Address
First Line : 1551 N VERMONT AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-5330
Country : US
Telephone Number : 323-953-0505
Fax Number :
Provider Business Practice Location Address
First Line : 1551 N VERMONT AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90027-5330
Country : US
Telephone Number : 323-953-0505
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. GEORGE DIG LIM
Credential : DMD
Telephone Number : 323-953-0505
Provider Enumeration Date : 06/25/2007
Last Update Date : 11/02/2020

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Directions to “GEORGE D. LIM DMD INC-HOLLYWOOD ” Practice Location

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