Healthcare Provider Details

I. General information

NPI: 1578857520
Provider Name (Legal Business Name): ADULT HEALTH CARE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 ARMY DR STE 105
TAMUNING GU
96913-1267
US

IV. Provider business mailing address

2211 ARMY DR STE 105
TAMUNING GU
96913-1267
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-5546
  • Fax: 671-647-5550
Mailing address:
  • Phone: 671-647-5546
  • Fax: 671-647-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberM-1378
License Number StateGU

VIII. Authorized Official

Name: DR. JOHNNY C LIM
Title or Position: PHYSICIAN
Credential: M.D
Phone: 671-647-5546