Individual provider Active NPI

Paul Clay Lim

  • Medical Physician Assistant
  • Fontana, CA
National Provider Identifier
1396479614
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA63478 Issued in CA
Practice address
9630 Sierra Ave Ste 100
Fontana, CA 92335-2415
Phone
(877) 693-6266
NPI assigned
Jul 12, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA63478 CA Primary

Addresses

Primary practice location

9630 Sierra Ave Ste 100
Fontana, CA 92335-2415

Mailing address

4720 E Atherton St Apt 23
Long Beach, CA 90815-3726
Phone (480) 865-4728

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260430004218 CA Practitioner - Physician Assistant 9739656307 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
At Still Un of HLTH Sciences, Col of Osteo Med, Mesa, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Exer Medical CorporationGroup PAC ID 9032359534, 336 clinicians

Practice addresses (Care Compare)

11126 Chandler Blvd
North Hollywood, CA 91601-3228
Phone (818) 985-0044

11560 W Pico Blvd
Los Angeles, CA 90064-1520
Phone (310) 477-8285

1300 N la Brea Ave
Los Angeles, CA 90028-7504
Phone (323) 464-1336

18700 Ventura Blvd
Suite 220
Tarzana, CA 91356-6317
Phone (747) 307-3323

19346 Nordhoff St
Northridge, CA 91324-2415
Phone (818) 727-2040

2090 Westwood Blvd
Los Angeles, CA 90025-6329
Phone (213) 814-4070

2300 Wilshire Blvd
Suite 104
Santa Monica, CA 90403-5863
Phone (424) 416-7900

26777 Agoura Rd
Suite B4
Calabasas, CA 91302-2967
Phone (818) 880-2225

4121 Santa Monica Blvd
Suite 103
Los Angeles, CA 90029-2270
Phone (213) 335-7355

4623 Eagle Rock Blvd
Los Angeles, CA 90041-3049
Phone (213) 878-5700

5717 Melrose Ave
Los Angeles, CA 90038-3807
Phone (323) 957-2273

7077 Willoughby Ave
Suite 3
Los Angeles, CA 90038-2396
Phone (323) 826-5333

8000 W Sunset Blvd
Suite C110
Los Angeles, CA 90046-2439
Phone (213) 412-0400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA63478CAMDMedical Physician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1396479614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4720 E ATHERTON ST APT 23",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908153726",
            "telephone_number": "480-865-4728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9630 SIERRA AVE STE 100",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923352415",
            "telephone_number": "877-693-6266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIM",
        "first_name": "PAUL",
        "middle_name": "CLAY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-12",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA63478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fontana, CA

Sources for this page

Verify at the official NPI Registry.