1578935797 NPI number — JEFFREY LIM, MD, INC.

Table of content: (NPI 1578935797)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578935797 NPI number — JEFFREY LIM, MD, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY LIM, MD, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1578935797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 25370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96825-0370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-536-0314
Provider Business Mailing Address Fax Number:
808-536-0320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 S KING ST
Provider Second Line Business Practice Location Address:
STE. 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:
808-941-7767
Provider Business Practice Location Address Fax Number:
808-947-3916
Provider Enumeration Date:
10/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
LIM
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
808-941-7767

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD-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".




Copyright © 2007-2025 www.npivalidator.com