Provider Demographics
NPI:1689953663
Name:LIM, SONNY SY (DMD)
Entity type:Individual
Prefix:DR
First Name:SONNY
Middle Name:SY
Last Name:LIM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 E GIBSON RD STE D
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95776-5161
Mailing Address - Country:US
Mailing Address - Phone:530-406-1730
Mailing Address - Fax:530-406-0108
Practice Address - Street 1:1837 E GIBSON RD STE D
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-5161
Practice Address - Country:US
Practice Address - Phone:530-406-1730
Practice Address - Fax:530-406-0108
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43363122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist