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General NPI Number Information
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NPI Number | 1437105251
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Entity Type | Individual
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Provider Name | GREGORY MATTHEW LIM M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 09/24/2020
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Provider Practice Location Address
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Address Line | 1783 EL CAMINO REAL
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City | BURLINGAME
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State | CA
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Zip | 94010-3205
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Country | US
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Telephone | 650-696-5515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6102
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City | NOVATO
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State | CA
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Zip | 94948-6102
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Country | US
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Telephone | 415-884-3418
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Fax | 415-883-0877
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | G17887
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G71887
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License Number State | CA
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