Provider Demographics
NPI:1093322158
Name:LEO GAN-LIM, M.D., PROF CORP
Entity Type:Organization
Organization Name:LEO GAN-LIM, M.D., PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:GAN-LIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-461-2707
Mailing Address - Street 1:2654 TOPAZ BLUE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:653 N TOWN CENTER DR STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0515
Practice Address - Country:US
Practice Address - Phone:702-485-2791
Practice Address - Fax:702-485-2812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty