Provider Demographics
NPI:1245234863
Name:LIM, AILEEN D (MD)
Entity Type:Individual
Prefix:DR
First Name:AILEEN
Middle Name:D
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:793 SOUTH TRACY BLVD
Mailing Address - Street 2:BOX 372
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376
Mailing Address - Country:US
Mailing Address - Phone:408-568-6524
Mailing Address - Fax:209-879-9093
Practice Address - Street 1:170 ALAMEDA DE LAS PULGA
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2751
Practice Address - Country:US
Practice Address - Phone:408-866-4060
Practice Address - Fax:408-866-3819
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2010-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG49660207ZP0102X, 207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G496600Medicare ID - Type Unspecified
F28572Medicare UPIN
CAF28572Medicare UPIN