Provider Demographics
NPI:1922576487
Name:LIM, JASON ANDY (NP)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ANDY
Last Name:LIM
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5451 LA PALMA AVE STE 47
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1732
Mailing Address - Country:US
Mailing Address - Phone:714-562-8560
Mailing Address - Fax:
Practice Address - Street 1:5451 LA PALMA AVE STE 47
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623-1732
Practice Address - Country:US
Practice Address - Phone:714-562-8560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010320363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care