Healthcare Provider Details

I. General information

NPI: 1083989529
Provider Name (Legal Business Name): THOMAS D LIM DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 12/23/2019
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3367 W 1ST ST STE 201
LOS ANGELES CA
90004-6080
US

IV. Provider business mailing address

3367 W 1ST ST STE 201
LOS ANGELES CA
90004-6080
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-4246
  • Fax: 213-483-7257
Mailing address:
  • Phone: 213-483-4246
  • Fax: 213-483-7257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4612
License Number StateCA

VIII. Authorized Official

Name: THOMAS D LIM
Title or Position: PROVIDER
Credential: DPM
Phone: 213-483-4246