Healthcare Provider Details

I. General information

NPI: 1982979050
Provider Name (Legal Business Name): ALBERT LIM MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5755 E KINGS CANYON RD SUITE 104
FRESNO CA
93727-4744
US

IV. Provider business mailing address

5755 E KINGS CANYON RD SUITE 104
FRESNO CA
93727-4744
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-7777
  • Fax:
Mailing address:
  • Phone: 559-255-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA50346
License Number StateCA

VIII. Authorized Official

Name: DR. ALBERT LIM
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 559-255-7777