Provider Demographics
NPI:1780670976
Name:LIM L TAW MEDICAL CORP.
Entity Type:Organization
Organization Name:LIM L TAW MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-241-2106
Mailing Address - Street 1:222 W EULALIA ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2849
Mailing Address - Country:US
Mailing Address - Phone:818-241-2106
Mailing Address - Fax:818-241-8730
Practice Address - Street 1:222 W EULALIA ST
Practice Address - Street 2:SUITE 311
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2849
Practice Address - Country:US
Practice Address - Phone:818-241-2106
Practice Address - Fax:818-241-8730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30992207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26304Medicare UPIN