MEDICARE: KENNETH LIM MD

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
1	208800000X	Urology Physician	0101282272	VA

General Provider Information

NPI Number	:	1164982641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH LIM MD

Provider Business Mailing Address
First Line	:	3700 JOSEPH SIEWICK DR STE 300
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1739
Country	:	US
Telephone Number	:	703-680-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 JOSEPH SIEWICK DR STE 300
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1739
Country	:	US
Telephone Number	:	703-680-2111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2019
Last Update Date	:	10/24/2024

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Directions to “ KENNETH LIM MD” Practice Location

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