Provider Demographics
NPI:1144321514
Name:HERBERT L. LIM, MD, INC.
Entity type:Organization
Organization Name:HERBERT L. LIM, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-523-1658
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 801
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-523-1658
Mailing Address - Fax:808-533-1201
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 801
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-523-1658
Practice Address - Fax:808-533-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD6498174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI208415OtherHMA, INC.
HI06020202Medicaid
HIB7998-4OtherHAWAII MEDICAL SVC ASSN
HIH0000BDWQBMedicare ID - Type Unspecified
100012821Medicare ID - Type UnspecifiedMEDICARE RAILROAD
HI208415OtherHMA, INC.