Provider Demographics
NPI:1396479614
Name:LIM, PAUL CLAY
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:CLAY
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 E ATHERTON ST APT 23
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-3726
Mailing Address - Country:US
Mailing Address - Phone:480-865-4728
Mailing Address - Fax:
Practice Address - Street 1:9630 SIERRA AVE STE 100
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-2415
Practice Address - Country:US
Practice Address - Phone:877-693-6266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63478363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical