Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DDS101029 | CA |
Y | 1223P0221X | Pediatric Dentist | DE60882689 | WA |
NPI | 1073045027 |
---|---|
Provider Name | Dr. Dongkook Dennis Lim |
First Address | Kirkland, WA 98033-4102 |
Second Address | Alhambra, CA 91803-1723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2017 |
Last Update Date | 25/02/2021 |