Provider Demographics
NPI:1376267526
Name:LIM, HYUNTAE
Entity Type:Individual
Prefix:
First Name:HYUNTAE
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1946 STARVINE WAY # 190719
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-4606
Mailing Address - Country:US
Mailing Address - Phone:858-414-7834
Mailing Address - Fax:
Practice Address - Street 1:1946 STARVINE WAY # 190719
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-4606
Practice Address - Country:US
Practice Address - Phone:858-414-7834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician