Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207T00000X | Neurosurgeon | 0101240401 | VA |
Y | 207T00000X | Neurosurgeon | A060129 | CA |
NPI | 1083657910 |
---|---|
Provider Name | Dr. Jae Y Lim |
First Address | Reston, VA 20190-3300 |
Second Address | Reston, VA 20190-3300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6186-0001 | CAREFIRST ID (01) | |
H02224 | (02) | WA |