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General NPI Number Information
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NPI Number | 1376116673
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Entity Type | Individual
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Provider Name | LUANA JI HEE LIM
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Gender | Female
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Dates
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Enumeration Date | 07/23/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 6331 HAVEN AVE STE 12
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91737-6942
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Country | US
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Telephone | 909-989-7222
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Fax |
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Provider Business Mailing Address
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Address Line | 2613 S ERIN WAY
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-4181
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Country | US
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Telephone | 818-455-9106
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DDS104287
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License Number State | CA
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