Provider Demographics
NPI:1730672601
Name:LIM, SUNGSOON (L AC)
Entity Type:Individual
Prefix:MR
First Name:SUNGSOON
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-5052
Mailing Address - Country:US
Mailing Address - Phone:201-240-1234
Mailing Address - Fax:
Practice Address - Street 1:17 FOX RUN DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-5052
Practice Address - Country:US
Practice Address - Phone:201-240-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00131200171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist