Healthcare Provider Details

I. General information

NPI: 1629654264
Provider Name (Legal Business Name): JONATHAN LIM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4476 TWEEDY BLVD STE B
SOUTH GATE CA
90280-6359
US

IV. Provider business mailing address

4476 TWEEDY BLVD STE B
SOUTH GATE CA
90280-6359
US

V. Phone/Fax

Practice location:
  • Phone: 323-825-8300
  • Fax: 323-268-9119
Mailing address:
  • Phone: 323-825-8300
  • Fax: 323-268-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1629654264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: