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NPI Code Detail

MEDICARE: DR. SANDRA SHAN LIM DO

MEDICARE: DR. SANDRA SHAN LIM DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician20A13075CA

General Provider Information

NPI Number : 1083963094
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SANDRA SHAN LIM DO
Provider Business Mailing Address
First Line : UCSD DEPARTMENT OF PSYCHIATRY
Second Line : 9500 GILMAN DRIVE, 9116A
City : LA JOLLA
State : CA
Zip : 92093-0001
Country : US
Telephone Number : 858-534-4040
Fax Number : 858-822-0231
Provider Business Practice Location Address
First Line : 1250 6TH AVE STE 100
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-4368
Country : US
Telephone Number : 619-515-2430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2012
Last Update Date : 03/17/2018

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