1275506412 NPI number — DR. NANCY GO LIM MD

Table of content: DR. NANCY GO LIM MD (NPI 1275506412)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275506412 NPI number — DR. NANCY GO LIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIM
Provider First Name:
NANCY
Provider Middle Name:
GO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1275506412
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
742 W HIGHLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92405-3839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-881-7320
Provider Business Mailing Address Fax Number:
909-881-7330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7965 SIERRA AVE STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92336
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-447-5554
Provider Business Practice Location Address Fax Number:
909-447-5582
Provider Enumeration Date:
02/08/2006

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: 207Q00000X , with the licence number:  C42912 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00C429121 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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