Provider Demographics
NPI:1508052341
Name:EDUARDO O LIM MEDICAL CORPORATION
Entity Type:Organization
Organization Name:EDUARDO O LIM MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:ONG
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-484-0146
Mailing Address - Street 1:PO BOX 26807
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-0807
Mailing Address - Country:US
Mailing Address - Phone:213-484-0146
Mailing Address - Fax:213-483-3032
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:SUITE 505
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2320
Practice Address - Country:US
Practice Address - Phone:213-484-0146
Practice Address - Fax:213-483-3032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49674174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A496740Medicaid
CA00A496741Medicaid
CA00A496741Medicaid
CA00A496740Medicaid
CAW17884AMedicare PIN