Provider Demographics
NPI:1477807717
Name:LIM, BEN K (PHD)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:K
Last Name:LIM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 AROSA ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3902
Mailing Address - Country:US
Mailing Address - Phone:619-752-0021
Mailing Address - Fax:
Practice Address - Street 1:2333 CAMINO DEL RIO S STE 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3616
Practice Address - Country:US
Practice Address - Phone:619-298-8722
Practice Address - Fax:619-298-5235
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46911106H00000X
TX4891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist