MEDICARE: DR. HANSEL LIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A208930	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1174225361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HANSEL LIM MD

Provider Business Mailing Address
First Line	:	1411 EAST 31ST ST
Second Line	:	A2 WING
City	:	OAKLAND
State	:	CA
Zip	:	94602
Country	:	US
Telephone Number	:	510-437-4800
Fax Number	:	510-535-7313

Provider Business Practice Location Address
First Line	:	1411 EAST 31ST ST
Second Line	:	A2 WING
City	:	OAKLAND
State	:	CA
Zip	:	94602
Country	:	US
Telephone Number	:	510-437-4800
Fax Number	:	510-535-7313

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	06/01/2026

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