Provider Demographics
NPI:1548243272
Name:LIM, HAE YOUNG (RPH)
Entity Type:Individual
Prefix:
First Name:HAE
Middle Name:YOUNG
Last Name:LIM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-1009
Mailing Address - Country:US
Mailing Address - Phone:213-382-0212
Mailing Address - Fax:213-382-0812
Practice Address - Street 1:928 S WESTERN AVE
Practice Address - Street 2:#110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-1000
Practice Address - Country:US
Practice Address - Phone:213-382-0212
Practice Address - Fax:213-382-0812
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH42278183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA436630Medicaid