Provider Demographics
NPI:1417511874
Name:LIM, MATTHEW ALLEN A (MD, MPH)
Entity Type:Individual
Prefix:
First Name:MATTHEW ALLEN
Middle Name:A
Last Name:LIM
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 PUNAHOU ST # 741
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1080
Mailing Address - Country:US
Mailing Address - Phone:808-369-1234
Mailing Address - Fax:
Practice Address - Street 1:1319 PUNAHOU ST # 741
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1080
Practice Address - Country:US
Practice Address - Phone:808-369-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7705208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics