Provider Demographics
NPI:1265494868
Name:LIM, JOHNNY C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:C
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2211 ARMY DRIVE, SUITE 105
Mailing Address - Street 2:ADULT HEALTH CARE CLINIC
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-0000
Mailing Address - Country:US
Mailing Address - Phone:671-647-5546
Mailing Address - Fax:671-647-5550
Practice Address - Street 1:2211 ARMY DRIVE, SUITE 105
Practice Address - Street 2:ADULT HEALTH CARE CLINIC
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-0000
Practice Address - Country:US
Practice Address - Phone:671-647-5546
Practice Address - Fax:671-647-5550
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GU174400000X
GUM-1378207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist