MEDICARE: MYOZA THERESA 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	208D00000X	General Practice Physician	A36593	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366515942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYOZA THERESA LIM MD

Provider Business Mailing Address
First Line	:	3030 W OLYMPIC BLVD
Second Line	:	#206
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-6501
Country	:	US
Telephone Number	:	213-739-8610
Fax Number	:	213-739-5771

Provider Business Practice Location Address
First Line	:	3030 W OLYMPIC BLVD
Second Line	:	#206
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-6501
Country	:	US
Telephone Number	:	213-739-8610
Fax Number	:	213-739-5771

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	09/22/2010

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Directions to “ MYOZA THERESA LIM MD” Practice Location

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