Active NPI
Jay Kyu Nam Lim, M.D.
- Pediatrics Physician
- Ada, OK
National Provider Identifier
1194256008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 50324
- Practice address
- 1921 Stonecipher Blvd
Ada, OK 74820-3439 - Phone
- (580) 436-3980
- NPI assigned
- Mar 22, 2017
- Last updated
- Oct 20, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 20257 | NV | |
| Pediatrics Physician | 208000000X | 50324 | OK | Primary |
Addresses
Primary practice location
1921 Stonecipher Blvd
Ada, OK 74820-3439
Mailing address
1921 Stonecipher Blvd
Ada, OK 74820-3439
Phone (580) 436-3980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20257 | NV | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1792454400000",
"number": "1194256008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1921 STONECIPHER BLVD",
"city": "ADA",
"state": "OK",
"postal_code": "748203439",
"telephone_number": "580-436-3980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1921 STONECIPHER BLVD",
"city": "ADA",
"state": "OK",
"postal_code": "748203439",
"telephone_number": "580-436-3980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIM",
"first_name": "JAY",
"middle_name": "KYU NAM",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-22",
"last_updated": "2026-10-20",
"certification_date": "2026-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NV",
"license": "20257",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "OK",
"license": "50324",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ada, OK
- Lighthouse Behavioral Wellness Centers
- Lighthouse Behavioral Wellness Centers
- Lighthouse Behavioral Wellness Centers
- Lighthouse Behavioral Wellness Centers (Ada URC)
- Christina Nicole Lillard, PT
- Lisa Van Triest-Peaden LCSW, Inc., P.C.
- Lauren Little Axe, PA
- James Wilson Little, D.PH.
- Jolene Jessica Lobo
- Virginia Loch
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.