MEDICARE: YOUNG SIK LIM, DDS, INC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1649879636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG SIK LIM, DDS, INC

Provider Business Mailing Address
First Line	:	11481 HEACOCK ST STE 160
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557-7906
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11481 HEACOCK ST STE 160
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557-7906
Country	:	US
Telephone Number	:	951-242-5470
Fax Number	:	951-242-5470

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. YOUNG SIK LIM
Credential	:
Telephone Number	:	909-654-1865

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	10/20/2020

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