Provider Demographics
NPI:1275211328
Name:LIM, JIN HEE (LMT)
Entity Type:Individual
Prefix:
First Name:JIN
Middle Name:HEE
Last Name:LIM
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12152 MONUMENT DR UNIT 284
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5506
Mailing Address - Country:US
Mailing Address - Phone:571-919-5342
Mailing Address - Fax:
Practice Address - Street 1:12152 MONUMENT DR UNIT 284
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-5506
Practice Address - Country:US
Practice Address - Phone:571-919-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019019095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist