Individual provider Active NPI

Jonathan Lim, DO

  • Pediatrics Physician
  • South Gate, CA
National Provider Identifier
1629654264
Registry record updated May 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
1629654264 Issued in CA
Practice address
4476 Tweedy Blvd Ste B
South Gate, CA 90280-6359
Phone
(323) 825-8300
Fax
(323) 268-9119
NPI assigned
Mar 23, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 1629654264 CA Primary

Addresses

Primary practice location

4476 Tweedy Blvd Ste B
South Gate, CA 90280-6359

Mailing address

4476 Tweedy Blvd Ste B
South Gate, CA 90280-6359
Phone (323) 825-8300

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250227002002 CA Practitioner - Pediatric Medicine 3375063860 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
1629654264CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Via Care Community Health Center CurrentSince Oct 24, 2024 Accepting new patients
Via Care Community Health Center CurrentSince Oct 24, 2024 Accepting new patients
Via Care Community Health Center Current Accepting new patients

Locations

10230 Artesia Blvd
Bellflower, CA 90706
Phone (562) 270-4100

501 S Atlantic Blvd
Los Angeles, CA 90022
Phone (323) 268-5442

507 S Atlantic Blvd
Los Angeles, CA 90022
Phone 32326891911067

4476 Tweedy Blvd
Ste B
South Gate, CA 90280
Phone (323) 825-8300

4476 Tweedy Blvd
South Gate, CA 90280
Phone (323) 563-9499

Organizations & group practices 3

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": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779753600000",
    "number": "1629654264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4476 TWEEDY BLVD STE B",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806359",
            "telephone_number": "323-825-8300",
            "fax_number": "323-268-9119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4476 TWEEDY BLVD STE B",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902806359",
            "telephone_number": "323-825-8300",
            "fax_number": "323-268-9119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIM",
        "first_name": "JONATHAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-23",
        "last_updated": "2026-05-26",
        "certification_date": "2026-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "1629654264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Gate, CA

Sources for this page

Verify at the official NPI Registry.