Active NPI
Krystle Sun Lim, DDS
- Dentist
- Santa Rosa, CA
National Provider Identifier
1417282369
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 58662
- Practice address
- 131 Stony Cir Ste 900
Santa Rosa, CA 95401-9512 - Phone
- (707) 579-1100
- NPI assigned
- Oct 9, 2009
- Last updated
- Dec 30, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 58662 | CA | Primary |
Addresses
Primary practice location
131 Stony Cir Ste 900
Santa Rosa, CA 95401-9512
Mailing address
131 Stony Cir Ste 900
Santa Rosa, CA 95401-9512
Phone (707) 579-1100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 58662 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1388361600000",
"number": "1417282369",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "131 STONY CIR STE 900",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954019512",
"telephone_number": "707-579-1100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "131 STONY CIR STE 900",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954019512",
"telephone_number": "707-579-1100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIM",
"first_name": "KRYSTLE",
"middle_name": "SUN",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-10-09",
"last_updated": "2013-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "58662",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.