MEDICARE: MICHELLE TO DDS AND ROGER LIM DDS APC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	46337	CA

General Provider Information

NPI Number	:	1285172866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE TO DDS AND ROGER LIM DDS APC

Provider Business Mailing Address
First Line	:	368 N LEMON AVE # C
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-2345
Country	:	US
Telephone Number	:	213-447-3294
Fax Number	:

Provider Business Practice Location Address
First Line	:	368 N LEMON AVE # C
Second Line	:
City	:	WALNUT
State	:	CA
Zip	:	91789-2345
Country	:	US
Telephone Number	:	213-447-3294
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHELLE TO
Credential	:	DDS
Telephone Number	:	213-447-3294

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	02/03/2017

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