MEDICARE: DR. JUNG LIM D.D.S.

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	1223E0200X	Endodontics	52079	CA

General Provider Information

NPI Number	:	1750557054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUNG LIM D.D.S.

Provider Business Mailing Address
First Line	:	73950 ALESSANDRO DR
Second Line	:	SUITE #6
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3637
Country	:	US
Telephone Number	:	760-340-3341
Fax Number	:	760-340-1088

Provider Business Practice Location Address
First Line	:	73950 ALESSANDRO DR
Second Line	:	SUITE #6
City	:	PALM DESERT
State	:	CA
Zip	:	92260-3637
Country	:	US
Telephone Number	:	760-340-3341
Fax Number	:	760-340-1088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	07/23/2009

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