Basic Information
| Provider Information | |||||||||
| NPI: | 1093322158 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEO GAN-LIM, M.D., PROF CORP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2440 PROFESSIONAL CT STE 110 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280839 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2440 PROFESSIONAL CT STE 110 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022408155 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2020 | ||||||||
| LastUpdateDate: | 09/24/2020 | ||||||||
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| AuthorizedOfficialLastName: | GAN-LIM | ||||||||
| AuthorizedOfficialFirstName: | LEONARDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 7024612707 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.