Healthcare Provider Details

I. General information

NPI: 1750502373
Provider Name (Legal Business Name): LISA LIM HUANG D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 ADAMS AVENUE SUITE 104 SIUTE 104
COSTA MESA CA
92626
US

IV. Provider business mailing address

1700 ADAMS AVENUE SIUTE 104
COSTA MESA CA
92626
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-0429
  • Fax: 714-545-0408
Mailing address:
  • Phone: 714-545-0429
  • Fax: 714-545-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number39415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: