Provider Demographics
NPI:1598241457
Name:LIM, KWANG-HO (CH60865318)
Entity Type:Individual
Prefix:DR
First Name:KWANG-HO
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:CH60865318
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8704 RAINIER AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-4927
Mailing Address - Country:US
Mailing Address - Phone:206-722-0299
Mailing Address - Fax:206-722-0436
Practice Address - Street 1:8704 RAINIER AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98118-4927
Practice Address - Country:US
Practice Address - Phone:206-722-0299
Practice Address - Fax:206-722-0436
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH60865318111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty