Provider Demographics
NPI:1386660447
Name:LIM, EDWARD MINA (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:MINA
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2201 FRANCISCO DR STE 140-129
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-3713
Mailing Address - Country:US
Mailing Address - Phone:510-755-5854
Mailing Address - Fax:844-461-6770
Practice Address - Street 1:2231 LINCOLN RD
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3907
Practice Address - Country:US
Practice Address - Phone:402-291-1203
Practice Address - Fax:402-291-3915
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2024-04-04
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Provider Licenses
StateLicense IDTaxonomies
CAA740542084P0800X
NE288902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH96388Medicare UPIN