Provider Demographics
NPI:1235259276
Name:LIM, JONATHAN EE-REN (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:EE-REN
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10606 CAMINO RUIZ STE 8
Mailing Address - Street 2:PMB 189
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3263
Mailing Address - Country:US
Mailing Address - Phone:858-395-3047
Mailing Address - Fax:
Practice Address - Street 1:10606 CAMINO RUIZ STE 8
Practice Address - Street 2:PMB 189
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-3263
Practice Address - Country:US
Practice Address - Phone:858-395-3047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAFE85332208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery