1508857384 NPI number — DR. JEFFREY LIM MD

Table of content: DR. JEFFREY LIM MD (NPI 1508857384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508857384 NPI number — DR. JEFFREY LIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIM
Provider First Name:
JEFFREY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1508857384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 S KING ST
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96826-3154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-941-7766
Provider Business Mailing Address Fax Number:
808-947-3916

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 S KING ST
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96826-3154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-941-7766
Provider Business Practice Location Address Fax Number:
808-947-3916
Provider Enumeration Date:
11/02/2005

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: 208000000X , with the licence number:  6124 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03205301 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".




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