Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 48637 | CA |
NPI | 1063547933 |
---|---|
Provider Name | Dr. Kathleen Sun Lim |
First Address | Redondo Beach, CA 90278-4712 |
Second Address | Tustin, CA 92780-3423 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 01/12/2021 |