Provider Demographics
NPI:1528572252
Name:LIM, TIMOTHY BYUNG JIN
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BYUNG JIN
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 HUNTINGTON DR STE C
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-2022
Mailing Address - Country:US
Mailing Address - Phone:626-234-2253
Mailing Address - Fax:626-234-2192
Practice Address - Street 1:2010 HUNTINGTON DR STE C
Practice Address - Street 2:
Practice Address - City:SAN MARINO
Practice Address - State:CA
Practice Address - Zip Code:91108-2022
Practice Address - Country:US
Practice Address - Phone:626-234-2253
Practice Address - Fax:626-234-2192
Is Sole Proprietor?:No
Enumeration Date:2017-11-16
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist