Provider Demographics
NPI:1083963094
Name:LIM, SANDRA SHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:SHAN
Last Name:LIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCSD DEPARTMENT OF PSYCHIATRY
Mailing Address - Street 2:9500 GILMAN DRIVE, 9116A
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92093-0001
Mailing Address - Country:US
Mailing Address - Phone:858-534-4040
Mailing Address - Fax:858-822-0231
Practice Address - Street 1:1250 6TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4368
Practice Address - Country:US
Practice Address - Phone:619-515-2430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A130752084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry