Provider Demographics
NPI:1003116013
Name:LIM, IN SOOK (DOM)
Entity Type:Individual
Prefix:DR
First Name:IN
Middle Name:SOOK
Last Name:LIM
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:DR
Other - First Name:MYEONG
Other - Middle Name:SOO
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DOM
Mailing Address - Street 1:9796 GARDEN GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1615
Mailing Address - Country:US
Mailing Address - Phone:714-590-3246
Mailing Address - Fax:
Practice Address - Street 1:9796 GARDEN GROVE BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844
Practice Address - Country:US
Practice Address - Phone:714-590-3246
Practice Address - Fax:714-590-3256
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5745171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist