MEDICARE: DR. ANGELA WING-CHEE LIM D.O.

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	5101016843	MI
2	207Q00000X	Family Medicine Physician	5101016843	MI
3	207Q00000X	Family Medicine Physician	20A11297	CA
4	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	20A11297	CA

General Provider Information

NPI Number	:	1184842007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA WING-CHEE LIM D.O.

Provider Business Mailing Address
First Line	:	1535 RIVER PARK DR STE 2000
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4601
Country	:	US
Telephone Number	:	916-286-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1535 RIVER PARK DR STE 2000
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95815-4601
Country	:	US
Telephone Number	:	916-286-1010
Fax Number	:

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	09/22/2021

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