Provider Demographics
NPI:1275506412
Name:LIM, NANCY GO (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:GO
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:742 W HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-3839
Mailing Address - Country:US
Mailing Address - Phone:909-881-7320
Mailing Address - Fax:909-881-7330
Practice Address - Street 1:7965 SIERRA AVE STE E
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336
Practice Address - Country:US
Practice Address - Phone:909-447-5554
Practice Address - Fax:909-447-5582
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2018-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC42912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C429121Medicaid
C31681Medicare UPIN
CA00C429121Medicaid