MEDICARE: 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

General Provider Information

NPI Number	:	1891995833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIM DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1211 N VERMONT AVE
Second Line	:	#102
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1748
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 N VERMONT AVE
Second Line	:	#102
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1748
Country	:	US
Telephone Number	:	323-666-7562
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALBERT LIM
Credential	:
Telephone Number	:	323-666-7562

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/18/2007

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Directions to “LIM DENTAL CORPORATION ” Practice Location

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