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General NPI Number Information
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NPI Number | 1336287432
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Entity Type | Organization
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Legal Business Name | FRED LIM, M.D., INC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 1420 S CENTRAL AVE
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City | GLENDALE
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State | CA
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Zip | 91204-2508
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Country | US
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Telephone | 818-588-6653
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Fax | 626-795-4894
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Provider Business Mailing Address
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Address Line | 700 E UNION ST UNIT 209
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City | PASADENA
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State | CA
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Zip | 91101-5667
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Country | US
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Telephone | 818-624-7000
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Fax | 626-795-4894
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRED T. LIM
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Credential | M.D.
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Telephone | 818-949-8877
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A75403
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | A75403
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License Number State | CA
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