Provider Demographics
NPI:1861275109
Name:LIM, YOUNGHUN (DMD)
Entity type:Individual
Prefix:DR
First Name:YOUNGHUN
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:HENRY
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1500 HAMILTON ST APT 1432
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2557
Mailing Address - Country:US
Mailing Address - Phone:609-672-0743
Mailing Address - Fax:
Practice Address - Street 1:801 OLD YORK RD STE 403
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-1625
Practice Address - Country:US
Practice Address - Phone:215-277-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0443221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice