Provider Demographics
NPI:1417175233
Name:FONG, CAROLINE LIM (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:LIM
Last Name:FONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CAROLINE
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:804 E ROSS AVE
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5517
Mailing Address - Country:US
Mailing Address - Phone:626-340-9887
Mailing Address - Fax:
Practice Address - Street 1:1505 N EDGEMONT ST
Practice Address - Street 2:BASEMENT - DIAGNOSTIC IMAGING
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5209
Practice Address - Country:US
Practice Address - Phone:323-783-5791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA941722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology