Healthcare Provider Details

I. General information

NPI: 1720083157
Provider Name (Legal Business Name): REDWOOD PULMONARY MEDICAL ASSOCIATES A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 ALAMEDA DE LAS PULGAS
REDWOOD CITY CA
94062-2751
US

IV. Provider business mailing address

170 ALAMEDA DE LAS PULGAS
REDWOOD CITY CA
94062-2751
US

V. Phone/Fax

Practice location:
  • Phone: 650-367-5636
  • Fax: 650-367-5110
Mailing address:
  • Phone: 650-367-5636
  • Fax: 650-367-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberG74100
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberG74100
License Number StateCA

VIII. Authorized Official

Name: MELISSA SUSANN LIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 650-367-5636