Healthcare Provider Details

I. General information

NPI: 1003547225
Provider Name (Legal Business Name): JONGOH LIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2022
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 EXPOSITION BLVD
SACRAMENTO CA
95815-5149
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-731-7728
  • Fax: 916-731-7815
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA207592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: