Provider Demographics
NPI:1194256008
Name:LIM, JAY KYU NAM (MD)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:KYU NAM
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10105 BANBURRY CROSS DRIVE, SUITE 370
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144
Mailing Address - Country:US
Mailing Address - Phone:702-260-4525
Mailing Address - Fax:702-897-2896
Practice Address - Street 1:10105 BANBURRY CROSS DRIVE, SUITE 370
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144
Practice Address - Country:US
Practice Address - Phone:702-260-4525
Practice Address - Fax:702-897-2896
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20257208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics