Provider Demographics
NPI:1750466371
Name:LIM, PEDRO KHO (MD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:KHO
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1299
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1299
Mailing Address - Country:US
Mailing Address - Phone:606-324-0672
Mailing Address - Fax:
Practice Address - Street 1:3123 FORESTVIEW DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41102-6782
Practice Address - Country:US
Practice Address - Phone:606-324-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16463208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1316201Medicare ID - Type UnspecifiedMEDICARE NUMBER