Provider Demographics
NPI:1104857424
Name:LIM, ALBERT LOPEZ (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:LOPEZ
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5755 E KINGS CANYON RD
Mailing Address - Street 2:#104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-4744
Mailing Address - Country:US
Mailing Address - Phone:559-255-7777
Mailing Address - Fax:559-454-1091
Practice Address - Street 1:5755 E KINGS CANYON RD
Practice Address - Street 2:#104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-4744
Practice Address - Country:US
Practice Address - Phone:559-255-7777
Practice Address - Fax:559-454-1091
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA50346174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7883234Medicare UPIN