Healthcare Provider Details

I. General information

NPI: 1255729679
Provider Name (Legal Business Name): MICHAEL S LIM D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2015
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12155 MORA DR STE 15
SANTA FE SPRINGS CA
90670-6034
US

IV. Provider business mailing address

12155 MORA DR STE 15
SANTA FE SPRINGS CA
90670-6034
US

V. Phone/Fax

Practice location:
  • Phone: 562-903-7741
  • Fax:
Mailing address:
  • Phone: 562-903-7741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number64040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: