Healthcare Provider Details

I. General information

NPI: 1578935797
Provider Name (Legal Business Name): JEFFREY LIM, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2015
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S KING ST STE. 308
HONOLULU HI
96826-3154
US

IV. Provider business mailing address

PO BOX 25370
HONOLULU HI
96825-0370
US

V. Phone/Fax

Practice location:
  • Phone: 808-941-7767
  • Fax: 808-947-3916
Mailing address:
  • Phone: 808-536-0314
  • Fax: 808-536-0320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-6124
License Number StateHI

VIII. Authorized Official

Name: DR. JEFFREY LIM
Title or Position: OWNER
Credential: MD
Phone: 808-941-7767