MEDICARE: DR. HYUN SANG 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	DN122932	GA
2	1223G0001X	General Practice Dentistry	34995	TX

General Provider Information

NPI Number	:	1871044107
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HYUN SANG LIM D.D.S

Provider Business Mailing Address
First Line	:	4256 TILLY MILL RD APT 1201
Second Line	:
City	:	DORAVILLE
State	:	GA
Zip	:	30360-3179
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 CONCORD RD SE
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30082-2619
Country	:	US
Telephone Number	:	770-405-8707
Fax Number	:

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

Provider Enumeration Date	:	10/21/2016
Last Update Date	:	08/07/2023

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Directions to “ DR. HYUN SANG LIM D.D.S” Practice Location

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