Healthcare Provider Details

I. General information

NPI: 1407126493
Provider Name (Legal Business Name): DJON INDRA LIM, M.D. FACP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2012
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 AUPUNI ST. SUITE 140
HILO HI
96720-4265
US

IV. Provider business mailing address

101 AUPUNI ST. SUITE 140
HILO HI
96720-4265
US

V. Phone/Fax

Practice location:
  • Phone: 808-969-3884
  • Fax: 808-969-3887
Mailing address:
  • Phone: 808-969-3884
  • Fax: 808-969-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD2282
License Number StateHI

VIII. Authorized Official

Name: DR. DJON INDRA LIM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 808-969-3884