Provider Demographics
NPI:1083957989
Name:LIM, DAPHNE (LAC)
Entity Type:Individual
Prefix:MS
First Name:DAPHNE
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 PRESTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-1864
Mailing Address - Country:US
Mailing Address - Phone:646-342-3255
Mailing Address - Fax:
Practice Address - Street 1:1159 LOGAN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-3210
Practice Address - Country:US
Practice Address - Phone:646-342-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-29
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16149171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist