Provider Demographics
NPI:1841984952
Name:LIM, NICHOLAS DAVY (RD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:DAVY
Last Name:LIM
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 KEHOE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1017
Mailing Address - Country:US
Mailing Address - Phone:650-918-9289
Mailing Address - Fax:
Practice Address - Street 1:2414 KEHOE AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1017
Practice Address - Country:US
Practice Address - Phone:650-918-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86172508133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered