Provider Demographics
NPI:1316030158
Name:JOHN C LIM MD & FRANCINE F ITO MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOHN C LIM MD & FRANCINE F ITO MD A PROFESSIONAL CORPORATION
Other - Org Name:JOHN C. LIM MD AND FRANCINE F ITO MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHIN-TIONG
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-5599
Mailing Address - Street 1:PO BOX 3098
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3098
Mailing Address - Country:US
Mailing Address - Phone:310-540-5599
Mailing Address - Fax:
Practice Address - Street 1:4201 TORRANCE BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4504
Practice Address - Country:US
Practice Address - Phone:310-540-5599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63053207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG52785Medicaid
CAG63053Medicaid
CAG52785Medicaid
CAG63053Medicaid
CAA93175Medicare UPIN