Provider Demographics
NPI:1407126493
Name:DJON INDRA LIM, M.D. FACP, INC.
Entity Type:Organization
Organization Name:DJON INDRA LIM, M.D. FACP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DJON
Authorized Official - Middle Name:INDRA
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-969-3884
Mailing Address - Street 1:101 AUPUNI ST.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4265
Mailing Address - Country:US
Mailing Address - Phone:808-969-3884
Mailing Address - Fax:808-969-3887
Practice Address - Street 1:101 AUPUNI ST.
Practice Address - Street 2:SUITE 140
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4265
Practice Address - Country:US
Practice Address - Phone:808-969-3884
Practice Address - Fax:808-969-3887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DJON INDRA LIM, M.D. FACP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2282207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03524301Medicaid
HIA0038933OtherHMSA
HIA0038933OtherHMSA