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General NPI Number Information
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NPI Number | 1396479614
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Entity Type | Individual
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Provider Name | PAUL CLAY LIM
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Gender | Male
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Dates
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Enumeration Date | 07/12/2022
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 9630 SIERRA AVE STE 100
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City | FONTANA
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State | CA
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Zip | 92335-2415
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Country | US
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Telephone | 877-693-6266
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Fax |
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Provider Business Mailing Address
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Address Line | 4720 E ATHERTON ST APT 23
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City | LONG BEACH
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State | CA
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Zip | 90815-3726
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Country | US
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Telephone | 480-865-4728
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA63478
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License Number State | CA
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