Provider Demographics
NPI:1801805163
Name:LIM, DEE BENG KO (MD)
Entity type:Individual
Prefix:DR
First Name:DEE BENG
Middle Name:KO
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9675 MONTE VISTA AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2233
Mailing Address - Country:US
Mailing Address - Phone:909-447-5554
Mailing Address - Fax:909-447-5582
Practice Address - Street 1:9675 MONTE VISTA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2233
Practice Address - Country:US
Practice Address - Phone:909-447-5554
Practice Address - Fax:909-447-5582
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAC39980207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C399801Medicaid
CAC39980Medicare ID - Type Unspecified
CA00C399801Medicaid