Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G75239 | CA |
NPI | 1033195128 |
---|---|
Provider Name | Paul Lim |
First Address | Calabasas, CA 91302-1549 |
Second Address | Calabasas, CA 91302-1549 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G05784 | (02) | CA |