Healthcare Provider Details

I. General information

NPI: 1356842553
Provider Name (Legal Business Name): MORAKOD LIM MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18231 US HIGHWAY 18 SUITE 5
APPLE VALLEY CA
92307-2213
US

IV. Provider business mailing address

18231 US HIGHWAY 18 SUITE 6
APPLE VALLEY CA
92307-2213
US

V. Phone/Fax

Practice location:
  • Phone: 760-946-5177
  • Fax: 760-946-5133
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG80993
License Number StateCA

VIII. Authorized Official

Name: MORAKOD LIM
Title or Position: PHYSICIAN
Credential: MD
Phone: 760-946-5177