Healthcare Provider Details

I. General information

NPI: 1710383724
Provider Name (Legal Business Name): VIVIAN LIM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 DAY CREEK BLVD STE 110
RANCHO CUCAMONGA CA
91739-7543
US

IV. Provider business mailing address

411 N LINCOLN AVE
MONTEREY PARK CA
91755-1205
US

V. Phone/Fax

Practice location:
  • Phone: 909-803-1111
  • Fax:
Mailing address:
  • Phone: 617-797-2214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number105939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: