Provider Demographics
NPI:1831160969
Name:LIM, LEYEN (OD)
Entity type:Individual
Prefix:DR
First Name:LEYEN
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 TRUMAN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-3237
Mailing Address - Country:US
Mailing Address - Phone:818-361-2020
Mailing Address - Fax:818-361-6381
Practice Address - Street 1:1101 TRUMAN ST
Practice Address - Street 2:SUITE E
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-3237
Practice Address - Country:US
Practice Address - Phone:818-361-2020
Practice Address - Fax:818-361-6381
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT12233T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP12233Medicaid
CAW18814OtherMEDICARE GROUP I.D.
CAU96647Medicare UPIN
CAWOP12233AMedicare ID - Type Unspecified