Leslie Lim Rudolph, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

14530 Issued in CA

Practice address

1525 Superior Ave
Suite 214
Newport Beach, CA 92663-3639

Phone

(949) 722-7902

Fax

(949) 722-7903

NPI assigned

Feb 4, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1486166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486166400000",
    "number": "1558809095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7469",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926157469",
            "telephone_number": "714-962-1586",
            "fax_number": "714-962-1586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 SUPERIOR AVE",
            "address_2": "SUITE 214",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633639",
            "telephone_number": "949-722-7902",
            "fax_number": "949-722-7903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUDOLPH",
        "first_name": "LESLIE",
        "middle_name": "LIM",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-04",
        "last_updated": "2017-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "14530",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "14530",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physician Assistant in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.