=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568594315
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERALD LIM D.D.S.,M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 74120 EL PASEO SUITE 2
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92260-4120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-568-5488
-----------------------------------------------------
Fax | 760-568-4668
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 74120 EL PASEO SUITE 2
-----------------------------------------------------
City | PALM DESERT
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92260-4120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-568-5488
-----------------------------------------------------
Fax | 760-568-4668
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | 38713
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------