Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | A106613 | CA |
NPI | 1134328735 |
---|---|
Provider Name | Dr. Kellie Jane Lim |
First Address | Fresno, CA 93720-2457 |
Second Address | Fresno, CA 93720-2457 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 24/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
GR0043790 | (05) | CA |
ZZZ21572Z | MEDICARE PTAN (01) | CA |