Healthcare Provider Details

I. General information

NPI: 1174225361
Provider Name (Legal Business Name): HANSEL LIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 EAST 31ST ST A2 WING
OAKLAND CA
94602
US

IV. Provider business mailing address

1411 EAST 31ST ST A2 WING
OAKLAND CA
94602
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4800
  • Fax: 510-535-7313
Mailing address:
  • Phone: 510-437-4800
  • Fax: 510-535-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA208930
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: