Healthcare Provider Details

I. General information

NPI: 1275775082
Provider Name (Legal Business Name): GEORGE D. LIM, DMD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2009
Last Update Date: 03/24/2021
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S FAIRFAX AVE
LOS ANGELES CA
90036-3133
US

IV. Provider business mailing address

401 S FAIRFAX AVE
LOS ANGELES CA
90036-3133
US

V. Phone/Fax

Practice location:
  • Phone: 323-951-0814
  • Fax:
Mailing address:
  • Phone: 323-951-0814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number43190
License Number StateCA

VIII. Authorized Official

Name: MRS. MILAGROS L. LIM
Title or Position: HR ADMIN/ACCOUNTS
Credential:
Phone: 323-951-0814