Provider Demographics
NPI:1164589404
Name:LIM, MI-JIN (OD)
Entity Type:Individual
Prefix:DR
First Name:MI-JIN
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:638 CAMINO DE LOS MARES
Mailing Address - Street 2:A120
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2848
Mailing Address - Country:US
Mailing Address - Phone:949-493-2269
Mailing Address - Fax:949-493-2448
Practice Address - Street 1:638 CAMINO DE LOS MARES
Practice Address - Street 2:A120
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2848
Practice Address - Country:US
Practice Address - Phone:949-493-2269
Practice Address - Fax:949-493-2448
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10904T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7678936Medicaid