Provider Demographics
NPI:1508857384
Name:LIM, JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2525 S KING ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3154
Mailing Address - Country:US
Mailing Address - Phone:808-941-7766
Mailing Address - Fax:808-947-3916
Practice Address - Street 1:2525 S KING ST
Practice Address - Street 2:SUITE 308
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-3154
Practice Address - Country:US
Practice Address - Phone:808-941-7766
Practice Address - Fax:808-947-3916
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HI6124208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03205301Medicaid
C98499Medicare UPIN