Provider Demographics
NPI:1023227154
Name:LIM, PHILLIP H (DO, MPH)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:H
Last Name:LIM
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5832 BEACH BLVD UNIT 209
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-5501
Mailing Address - Country:US
Mailing Address - Phone:714-676-5541
Mailing Address - Fax:714-676-5542
Practice Address - Street 1:5832 BEACH BLVD UNIT 209
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-5501
Practice Address - Country:US
Practice Address - Phone:714-676-5541
Practice Address - Fax:714-676-5542
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9128207LP2900X, 207L00000X, 208VP0014X, 208VP0014X
HIDOS-1366207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABP008XMedicare PIN