Provider Demographics
NPI:1033134465
Name:LIM, PERRY F
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:F
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:PERRY
Other - Middle Name:F
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:198 DOUGLAS CT
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7724
Mailing Address - Country:US
Mailing Address - Phone:408-263-3076
Mailing Address - Fax:
Practice Address - Street 1:1206 N CAPITOL AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2572
Practice Address - Country:US
Practice Address - Phone:408-929-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53996208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A539960OtherPROVIDER NBR
CA0430935Medicaid
CAA53996OtherLICENSE NUMBER
CA0430935Medicare UPIN