Provider Demographics
NPI:1851408009
Name:LIM, PING SIM (MD)
Entity Type:Individual
Prefix:
First Name:PING
Middle Name:SIM
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1433 WEST MERCED AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-960-4994
Mailing Address - Fax:626-960-4994
Practice Address - Street 1:1433 WEST MERCED AVE
Practice Address - Street 2:STE 206
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-960-4994
Practice Address - Fax:626-960-4994
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA24845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A24845018Medicaid
B49996Medicare UPIN
CA00A24845018Medicaid