Provider Demographics
NPI:1659459642
Name:LIM, MARY EUGENIE (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EUGENIE
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6001 NORRIS CANYON RD
Mailing Address - Street 2:RM. 142
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-5400
Mailing Address - Country:US
Mailing Address - Phone:925-275-8848
Mailing Address - Fax:925-275-8299
Practice Address - Street 1:6001 NORRIS CANYON RD
Practice Address - Street 2:RM. 142
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5400
Practice Address - Country:US
Practice Address - Phone:925-275-8848
Practice Address - Fax:925-275-8299
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA75107208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics