Provider Demographics
NPI:1740618255
Name:LIM, SEON
Entity Type:Individual
Prefix:
First Name:SEON
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5024 66TH ST
Mailing Address - Street 2:1FL
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7533
Mailing Address - Country:US
Mailing Address - Phone:718-791-7994
Mailing Address - Fax:718-476-8594
Practice Address - Street 1:5024 66TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7533
Practice Address - Country:US
Practice Address - Phone:718-791-7994
Practice Address - Fax:718-476-8594
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152149251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)