Healthcare Provider Details

I. General information

NPI: 1205101573
Provider Name (Legal Business Name): DAVID WAI LIM M.D., C.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 W 145TH ST #4C4
NEW YORK NY
10031-5302
US

IV. Provider business mailing address

WINDSOR PARK PLAZA (TOWER 1) 11135 - 83RD AVENUE NW, SUITE 808
EDMONTON ALBERTA
T6G2C6
CA

V. Phone/Fax

Practice location:
  • Phone: 780-908-9245
  • Fax:
Mailing address:
  • Phone: 780-908-9245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: