Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4263 | CA |
Y | 222Z00000X | Podiatrist | E4263 | CA |
N | 213ES0131X | Foot Surgery | E4263 | CA |
NPI | 1073594727 |
---|---|
Provider Name | Dr. Jackson M Lim |
First Address | Yuba City, CA 95991-2960 |
Second Address | Yuba City, CA 95991-2960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 29/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E42630 | (05) | CA |
U80575 | (02) |