Provider Demographics
NPI:1629084603
Name:LIM, TIMOTHY A (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:A
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1801 W ROMNEYA DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1825
Mailing Address - Country:US
Mailing Address - Phone:714-533-9860
Mailing Address - Fax:714-533-0915
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:SUITE 302
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1825
Practice Address - Country:US
Practice Address - Phone:714-533-9860
Practice Address - Fax:714-533-0915
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG30940174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA44609Medicare UPIN