Healthcare Provider Details

I. General information

NPI: 1306436282
Provider Name (Legal Business Name): KATHLEEN S. LIM, DDS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18102 IRVINE BLVD STE 101
TUSTIN CA
92780-3423
US

IV. Provider business mailing address

18102 IRVINE BLVD STE 101
TUSTIN CA
92780-3423
US

V. Phone/Fax

Practice location:
  • Phone: 714-838-9120
  • Fax: 714-838-9161
Mailing address:
  • Phone: 714-838-9120
  • Fax: 714-838-9161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHLEEN SUN LIM
Title or Position: PRESIDENT/OWNER
Credential: DDS
Phone: 714-838-9120