Active NPI
Jae Hyung Lim, DDS
- General Practice Dentistry
- Fort Meade, MD
National Provider Identifier
1922453372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 11725
- Practice address
- 8472 Simmond St
Fort Meade, MD 20755-5700 - Phone
- (301) 677-7316
- NPI assigned
- May 3, 2016
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11725 | CT | Primary |
Addresses
Primary practice location
8472 Simmond St
Fort Meade, MD 20755-5700
Mailing address
8472 Simmond St
Fort Meade, MD 20755-5700
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 |
|---|---|---|---|
| 11725 | CT | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730160000000",
"number": "1922453372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8472 SIMMOND ST",
"city": "FORT MEADE",
"state": "MD",
"postal_code": "207555700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8472 SIMMOND ST",
"city": "FORT MEADE",
"state": "MD",
"postal_code": "207555700",
"telephone_number": "301-677-7316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIM",
"first_name": "JAE",
"middle_name": "HYUNG",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-05-03",
"last_updated": "2024-10-29",
"certification_date": "2024-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CT",
"license": "11725",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Meade, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.