{
"Npi": {
"NPI": "1508430968",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LIM",
"FirstName": "ALEX",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MD MPH",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1211 W LA PALMA AVE STE 404",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANAHEIM",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92801-2806",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-772-8282",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1211 W LA PALMA AVE STE 404",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ANAHEIM",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "92801-2806",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "520-694-8888",
"PracticeLocationAddressFaxNumber": "520-694-1640",
"EnumerationDate": "05/19/2021",
"LastUpdateDate": "11/05/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "207R00000X",
"TaxonomyName": "Internal Medicine Physician",
"LicenseNumber": "201333",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "R78625",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}