Healthcare Provider Details

I. General information

NPI: 1861814121
Provider Name (Legal Business Name): COLIN LIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 09/23/2025
Certification Date: 09/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOS ANGELES AIR FORCE BASE 483 N AVIATION BLVD BLDG 286
EL SEGUNDO CA
90245-2808
US

IV. Provider business mailing address

483 N AVIATION BLVD BLDG 286 SBD3-CDG
EL SEGUNDO CA
90245-2808
US

V. Phone/Fax

Practice location:
  • Phone: 310-653-1110
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801093953
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: