MEDICARE: TINA KANG-LIM

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	104100000X	Social Worker
2	103T00000X	Psychologist

General Provider Information

NPI Number	:	1861695470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA KANG-LIM

Provider Business Mailing Address
First Line	:	12442 SW SCHOLLS FERRY RD STE 100
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-0803
Country	:	US
Telephone Number	:	503-216-9200
Fax Number	:

Provider Business Practice Location Address
First Line	:	12442 SW SCHOLLS FERRY RD STE 100
Second Line	:
City	:	TIGARD
State	:	OR
Zip	:	97223-0803
Country	:	US
Telephone Number	:	503-216-9200
Fax Number	:

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

Provider Enumeration Date	:	06/09/2007
Last Update Date	:	12/01/2016

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Directions to “ TINA KANG-LIM ” Practice Location

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