Provider Demographics
NPI:1093770729
Name:LIM, THOMAS D (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:LIM
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:3367 W 1ST ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-6080
Mailing Address - Country:US
Mailing Address - Phone:213-483-4246
Mailing Address - Fax:213-483-7257
Practice Address - Street 1:3367 W 1ST ST STE 201
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6080
Practice Address - Country:US
Practice Address - Phone:213-483-4246
Practice Address - Fax:213-483-7257
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4612213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4612Medicare UPIN
V00669Medicare UPIN
CA5739990004Medicare NSC