Provider Demographics
NPI:1437256211
Name:LIM, GRACE WEE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:WEE
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26180
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6180
Mailing Address - Country:US
Mailing Address - Phone:559-244-6360
Mailing Address - Fax:559-222-9369
Practice Address - Street 1:5088 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-7611
Practice Address - Country:US
Practice Address - Phone:559-244-6360
Practice Address - Fax:559-222-9369
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA348632080P0201X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0070813Medicaid
CAA27608Medicare UPIN
CAA348630Medicare PIN