Provider Demographics
NPI:1275959439
Name:LIM, EJ (LAC, DACM)
Entity Type:Individual
Prefix:DR
First Name:EJ
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 PARKWOOD BLVD STE 706
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1920
Mailing Address - Country:US
Mailing Address - Phone:469-492-7920
Mailing Address - Fax:
Practice Address - Street 1:3550 PARKWOOD BLVD STE 706
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1920
Practice Address - Country:US
Practice Address - Phone:469-492-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15625171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist