Healthcare Provider Details

I. General information

NPI: 1073594727
Provider Name (Legal Business Name): JACKSON M LIM D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 10/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 PLUMAS CT SUITE A
YUBA CITY CA
95991-2960
US

IV. Provider business mailing address

1531 PLUMAS CT SUITE A
YUBA CITY CA
95991-2960
US

V. Phone/Fax

Practice location:
  • Phone: 530-674-9737
  • Fax: 530-674-9734
Mailing address:
  • Phone: 530-674-9737
  • Fax: 530-674-9734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4263
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberE4263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: