Provider Demographics
NPI:1285493155
Name:JOHNSTON LIM CO, MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:JOHNSTON LIM CO, MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-207-9969
Mailing Address - Street 1:2156 WEST GRANT LINE ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7336
Mailing Address - Country:US
Mailing Address - Phone:209-207-9969
Mailing Address - Fax:
Practice Address - Street 1:2156 WEST GRANT LINE ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7336
Practice Address - Country:US
Practice Address - Phone:209-207-9969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty