Provider Demographics
NPI:1801413471
Name:LIM, DEXHELYN MAE
Entity type:Individual
Prefix:
First Name:DEXHELYN MAE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4560 MOUNT TAYLOR DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-6225
Mailing Address - Country:US
Mailing Address - Phone:415-283-4371
Mailing Address - Fax:
Practice Address - Street 1:584 CASTRO ST STE 3070
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2512
Practice Address - Country:US
Practice Address - Phone:888-708-0561
Practice Address - Fax:404-719-4281
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1194223363LF0000X
COAPN.1000613-NP363LF0000X
NV866638363LF0000X
OR10041390363LF0000X
NY356388363LF0000X
UT14158069-4405363LF0000X
CA95014425363LF0000X
MI4704430527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily