Provider Demographics
NPI:1619994613
Name:CO, SCHENLEY LIM (MD)
Entity Type:Individual
Prefix:MR
First Name:SCHENLEY
Middle Name:LIM
Last Name:CO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3655 LOMITA BLVD STE 301
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3968
Mailing Address - Country:US
Mailing Address - Phone:310-377-2022
Mailing Address - Fax:310-377-2409
Practice Address - Street 1:3655 LOMITA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3968
Practice Address - Country:US
Practice Address - Phone:310-377-2202
Practice Address - Fax:310-377-2409
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA372342084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA37234COtherMEDICARE
CA00A372340OtherBLUE SHIELD
CA00A372341Medicaid
CA00A372341Medicaid