1225372295 NPI number — DR. EUGENE JONGIN LIM DDS

Table of content: DR. EUGENE JONGIN LIM DDS (NPI 1225372295)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225372295 NPI number — DR. EUGENE JONGIN LIM DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIM
Provider First Name:
EUGENE
Provider Middle Name:
JONGIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIM
Provider Other First Name:
JONG
Provider Other Middle Name:
IN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225372295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2955 HOPETON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CRESCENTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91214-1323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-606-1597
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
680 WILSHIRE PL
Provider Second Line Business Practice Location Address:
#411
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90005-3931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-738-7077
Provider Business Practice Location Address Fax Number:
213-738-0111
Provider Enumeration Date:
11/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  61943 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 61943 . This is a "DENTAL INSURANCE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com