Healthcare Provider Details

I. General information

NPI: 1295178564
Provider Name (Legal Business Name): STEPHANIE LIM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 PARNASSUS AVE DEPT OF ANESTHESIA, ROOM S436
SAN FRANCISCO CA
94143-2133
US

IV. Provider business mailing address

513 PARNASSUS AVE RM 455E
SAN FRANCISCO CA
94143-2205
US

V. Phone/Fax

Practice location:
  • Phone: 415-443-4625
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA124214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: