MEDICARE: DR. SONNY SY LIM D.M.D.

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	122300000X	Dentist	43363	CA

General Provider Information

NPI Number	:	1689953663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONNY SY LIM D.M.D.

Provider Business Mailing Address
First Line	:	1837 E GIBSON RD STE D
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95776-5161
Country	:	US
Telephone Number	:	530-406-1730
Fax Number	:	530-406-0108

Provider Business Practice Location Address
First Line	:	1837 E GIBSON RD STE D
Second Line	:
City	:	WOODLAND
State	:	CA
Zip	:	95776-5161
Country	:	US
Telephone Number	:	530-406-1730
Fax Number	:	530-406-0108

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

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	08/09/2011

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