Provider Demographics
NPI:1134319890
Name:LIM, MORAKOD (MD)
Entity Type:Individual
Prefix:
First Name:MORAKOD
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16850 BEAR VALLEY RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5794
Mailing Address - Country:US
Mailing Address - Phone:760-241-8000
Mailing Address - Fax:760-241-8000
Practice Address - Street 1:16850 BEAR VALLEY RD
Practice Address - Street 2:SUITE 105
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5794
Practice Address - Country:US
Practice Address - Phone:760-241-8000
Practice Address - Fax:760-241-8000
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2016-06-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG80993207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG27074Medicare UPIN