Provider Demographics
NPI:1720205008
Name:TAW, LIM L (MD)
Entity Type:Individual
Prefix:DR
First Name:LIM
Middle Name:L
Last Name:TAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1500 S CENTRAL AVE STE 314
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2573
Mailing Address - Country:US
Mailing Address - Phone:818-241-2106
Mailing Address - Fax:818-241-8730
Practice Address - Street 1:1500 S CENTRAL AVE STE 314
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2573
Practice Address - Country:US
Practice Address - Phone:818-241-2106
Practice Address - Fax:818-241-8730
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30992Medicare PIN