Provider Demographics
NPI:1356663553
Name:LIM, GRACE E (LAC)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:E
Last Name:LIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:15501 SAN FERNANDO MISSION BLVD STE 311
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1374
Mailing Address - Country:US
Mailing Address - Phone:818-403-6130
Mailing Address - Fax:818-403-6138
Practice Address - Street 1:15501 SAN FERNANDO MISSION BLVD STE 311
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1374
Practice Address - Country:US
Practice Address - Phone:818-403-6130
Practice Address - Fax:818-403-6138
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAAC12985171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist