1205101573 NPI number — DR. DAVID WAI LIM M.D., C.M.

Table of content: DR. DAVID WAI LIM M.D., C.M. (NPI 1205101573)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205101573 NPI number — DR. DAVID WAI LIM M.D., C.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIM
Provider First Name:
DAVID
Provider Middle Name:
WAI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., C.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205101573
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
WINDSOR PARK PLAZA (TOWER 1)
Provider Second Line Business Mailing Address:
11135 - 83RD AVENUE NW, SUITE 808
Provider Business Mailing Address City Name:
EDMONTON
Provider Business Mailing Address State Name:
ALBERTA
Provider Business Mailing Address Postal Code:
T6G2C6
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
780-908-9245
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 W 145TH ST
Provider Second Line Business Practice Location Address:
#4C4
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10031-5302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
780-908-9245
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5004322/001 OC . This is a "ACADEMIC MEDICAL PROFESSIONALS INSURANCE EXCHANGE RISK RETENTION GROUP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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