Provider Demographics
NPI:1093057499
Name:LIM, GRACE XIAO'EN (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:XIAO'EN
Last Name:LIM
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2 JAMES WAY STE 209
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-4976
Mailing Address - Country:US
Mailing Address - Phone:805-549-6915
Mailing Address - Fax:805-549-6916
Practice Address - Street 1:2 JAMES WAY STE 209
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-4976
Practice Address - Country:US
Practice Address - Phone:805-549-6915
Practice Address - Fax:805-549-6916
Is Sole Proprietor?:No
Enumeration Date:2013-03-23
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA143319208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics