Provider Demographics
NPI:1972526143
Name:LIM, MIIA H (MD)
Entity Type:Individual
Prefix:DR
First Name:MIIA
Middle Name:H
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MIIA
Other - Middle Name:H
Other - Last Name:HAVULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:22 PINEWOOD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:949-387-0157
Mailing Address - Fax:
Practice Address - Street 1:76 STATE STREET
Practice Address - Street 2:26TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109
Practice Address - Country:US
Practice Address - Phone:888-982-7956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248682207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program