Active NPI
Jaeyoung Lim
- Dentist
- La Canada Flintridge, CA
National Provider Identifier
1467336735
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 112083
- Practice address
- 400 Foothill Blvd
La Canada Flintridge, CA 91011-3503 - Phone
- (818) 790-3923
- NPI assigned
- Aug 1, 2025
- 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 | 112083 | CA | Primary |
Addresses
Primary practice location
400 Foothill Blvd
La Canada Flintridge, CA 91011-3503
Mailing address
941 Wiladonda Dr
La Canada Flintridge, CA 91011-2530
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 |
|---|---|---|---|
| 112083 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754006400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754006400000",
"number": "1467336735",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "941 WILADONDA DR",
"city": "LA CANADA FLINTRIDGE",
"state": "CA",
"postal_code": "910112530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 FOOTHILL BLVD",
"city": "LA CANADA FLINTRIDGE",
"state": "CA",
"postal_code": "910113503",
"telephone_number": "818-790-3923"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIM",
"first_name": "JAEYOUNG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-01",
"last_updated": "2025-08-01",
"certification_date": "2025-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "112083",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Canada Flintridge, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.