Healthcare Provider Details

I. General information

NPI: 1548924657
Provider Name (Legal Business Name): YOUNG LIM DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 10/25/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 WARRIOR DR
STEPHENS CITY VA
22655-4045
US

IV. Provider business mailing address

175 WARRIOR DR
STEPHENS CITY VA
22655-4045
US

V. Phone/Fax

Practice location:
  • Phone: 540-869-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. YOUNG LIM
Title or Position: AUTHORIZED OFFICIAL
Credential: DDS
Phone: 209-549-6203