1457324592 NPI number — DR. HAJIN LIM MD

Table of content: DR. HAJIN LIM MD (NPI 1457324592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457324592 NPI number — DR. HAJIN LIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIM
Provider First Name:
HAJIN
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:
1457324592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909 FROSTWOOD DR
Provider Second Line Business Mailing Address:
SUITE 1.100
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77024-2301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-338-4523
Provider Business Mailing Address Fax Number:
713-338-5500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
THE WOODLANDS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-3259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-897-7221
Provider Business Practice Location Address Fax Number:
713-897-7235
Provider Enumeration Date:
02/09/2006

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: 207RC0000X , with the licence number:  1999137431 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: P0624 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 34096011 . This is a "BCBS OF KC INDIVIDUAL #" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00179692 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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