Active NPI
Soo Hyun Lim, D.M.D
- Pediatric Dentistry
- La Canada, CA
National Provider Identifier
1477766756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 60072
- Practice address
- 4631 Hillard Ave
La Canada, CA 91011-2004 - Phone
- (917) 582-1707
- NPI assigned
- May 7, 2007
- Last updated
- Nov 23, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 60072 | CA | Primary |
Addresses
Primary practice location
4631 Hillard Ave
La Canada, CA 91011-2004
Mailing address
4631 Hillard Ave
La Canada, CA 91011-2004
Phone (917) 582-1707
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 |
|---|---|---|---|
| 60072 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448236800000",
"number": "1477766756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4631 HILLARD AVE",
"city": "LA CANADA",
"state": "CA",
"postal_code": "910112004",
"telephone_number": "917-582-1707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4631 HILLARD AVE",
"city": "LA CANADA",
"state": "CA",
"postal_code": "910112004",
"telephone_number": "917-582-1707"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIM",
"first_name": "SOO HYUN",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2015-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "CA",
"license": "60072",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Canada, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.