Healthcare Provider Details

I. General information

NPI: 1528288990
Provider Name (Legal Business Name): JENNIFER SIAO LIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15206 PARTHENIA ST
NORTH HILLS CA
91343-5305
US

IV. Provider business mailing address

13437 GLENWOOD DR
SYLMAR CA
91342-5658
US

V. Phone/Fax

Practice location:
  • Phone: 818-895-3100
  • Fax:
Mailing address:
  • Phone: 818-362-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301063957
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA63309
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: