1821152422 NPI number — KYUHO LIM DMD, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821152422 NPI number — KYUHO LIM DMD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KYUHO LIM DMD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KENDALL SQUARE DENTAL ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821152422
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 BRIARWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01890-3869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-729-1224
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 KENDALL SQ
Provider Second Line Business Practice Location Address:
BUILDING 300, SUITE 312
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02139-1562
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-577-8700
Provider Business Practice Location Address Fax Number:
617-577-0282
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIM
Authorized Official First Name:
KYUHO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-577-8700

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  14326 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: X10929KE . This is a "BCBS OF MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04614 . This is a "DELTA DENTAL OF MASS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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