=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003547225
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONGOH LIM MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2022
-----------------------------------------------------
Last Update Date | 10/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2323 MEMORIAL AVE STE 10
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-2652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-200-5200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3860 IH 10 EAST HOUSTON ST.
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78207-0903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-644-5060
-----------------------------------------------------
Fax | 210-702-6926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | W0649
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------