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General NPI Number Information
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NPI Number | 1851474217
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Entity Type | Organization
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Legal Business Name | TOTAL VASCULAR SURGERY INC
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Dates
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Enumeration Date | 10/21/2006
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 5 MEDICAL PLAZA DRIVE SUITE 200
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City | ROSEVILLE
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State | CA
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Zip | 95661-2867
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Country | US
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Telephone | 916-784-1836
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Fax | 916-784-1880
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Provider Business Mailing Address
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Address Line | 5 MEDICAL PLAZA DRIVE SUITE 200
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City | ROSEVILLE
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State | CA
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Zip | 95661-2867
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Country | US
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Telephone | 916-784-1836
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Fax | 916-784-1880
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Authorized Official
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Title or Position | OWNER AND SURGEON
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Name | JUNG J LIM
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Credential | D.O.
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Telephone | 916-784-1836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 20A8767
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License Number State | CA
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