MEDICARE: DR. RISKA K. LIM D.D.S.

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	1223G0001X	General Practice Dentistry	37129	CA
2	1223G0001X	General Practice Dentistry	19-021747	IL

General Provider Information

NPI Number	:	1518183599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RISKA K. LIM D.D.S.

Provider Business Mailing Address
First Line	:	2228 HITCHCOCK DR
Second Line	:
City	:	ALHAMBRA
State	:	CA
Zip	:	91803-4505
Country	:	US
Telephone Number	:	626-823-3884
Fax Number	:

Provider Business Practice Location Address
First Line	:	1241 S SOTO ST
Second Line	:	117
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-2652
Country	:	US
Telephone Number	:	323-264-2410
Fax Number	:	323-264-2241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	08/15/2014

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