Provider Demographics
NPI:1396286720
Name:LIM, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11480 BROOKSHIRE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5023
Mailing Address - Country:US
Mailing Address - Phone:562-904-4466
Mailing Address - Fax:562-904-4467
Practice Address - Street 1:11480 BROOKSHIRE AVE STE 204
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5023
Practice Address - Country:US
Practice Address - Phone:562-904-4466
Practice Address - Fax:562-904-4467
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA157848207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program