Provider Demographics
NPI:1134311905
Name:LIM, WAYLAND (MD)
Entity Type:Individual
Prefix:
First Name:WAYLAND
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 TREAT BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2485 HIGH SCHOOL AVE
Practice Address - Street 2:STE 100
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1816
Practice Address - Country:US
Practice Address - Phone:925-671-0610
Practice Address - Fax:925-671-0878
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA105972207RI0011X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA186948Medicare PIN