MEDICARE: MEDIA LIMA DENTAL LLC

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

General Provider Information

NPI Number	:	1699610683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDIA LIMA DENTAL LLC

Provider Business Mailing Address
First Line	:	1180 W BALTIMORE PIKE
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-5128
Country	:	US
Telephone Number	:	610-892-9280
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 W BALTIMORE PIKE
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-5128
Country	:	US
Telephone Number	:	610-892-9280
Fax Number	:

Authorized Official
Title or Position	:	PEDIATRIC DENTIST
Name	:	DR. JOHN KWON
Credential	:	DMD
Telephone Number	:	610-892-9280

Provider Enumeration Date	:	04/23/2026
Last Update Date	:	04/23/2026

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Directions to “MEDIA LIMA DENTAL LLC ” Practice Location

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