Provider Demographics
NPI:1154412849
Name:LIM, BRIAN R K B (PHD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:R K B
Last Name:LIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:R K B
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:410 KEOLU DR
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-4267
Mailing Address - Country:US
Mailing Address - Phone:808-262-7715
Mailing Address - Fax:808-262-5154
Practice Address - Street 1:970 N KALAHEO AVE
Practice Address - Street 2:SUITE A-212
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-1801
Practice Address - Country:US
Practice Address - Phone:808-225-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY924103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical