Provider Demographics
NPI:1770507071
Name:LIM, JOCELYN GAYLE (DO)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:GAYLE
Last Name:LIM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 POWELL ST
Mailing Address - Street 2:STE 900
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1826
Mailing Address - Country:US
Mailing Address - Phone:510-350-2600
Mailing Address - Fax:
Practice Address - Street 1:9460 N NAME UNO
Practice Address - Street 2:STE 230
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-3537
Practice Address - Country:US
Practice Address - Phone:408-842-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF36888Medicare UPIN