MEDICARE: DR. NANCY GO 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	207Q00000X	Family Medicine Physician	C42912	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275506412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY GO LIM MD

Provider Business Mailing Address
First Line	:	742 W HIGHLAND AVE
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92405-3839
Country	:	US
Telephone Number	:	909-881-7320
Fax Number	:	909-881-7330

Provider Business Practice Location Address
First Line	:	7965 SIERRA AVE STE E
Second Line	:
City	:	FONTANA
State	:	CA
Zip	:	92336
Country	:	US
Telephone Number	:	909-447-5554
Fax Number	:	909-447-5582

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/21/2018

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