Healthcare Provider Details

I. General information

NPI: 1275983488
Provider Name (Legal Business Name): JI LIM DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2016
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1054 E GRAND AVE STE C
ARROYO GRANDE CA
93420-2527
US

IV. Provider business mailing address

1054 E GRAND AVE STE C
ARROYO GRANDE CA
93420-2527
US

V. Phone/Fax

Practice location:
  • Phone: 805-960-3636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number108483
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: