Provider Demographics
NPI:1760543730
Name:LIM, BANYA (LAC)
Entity Type:Individual
Prefix:MS
First Name:BANYA
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 RUFOUS LN
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-7118
Mailing Address - Country:US
Mailing Address - Phone:928-567-7897
Mailing Address - Fax:928-567-7858
Practice Address - Street 1:340 JORDAN RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4804
Practice Address - Country:US
Practice Address - Phone:928-567-7897
Practice Address - Fax:928-567-7858
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0414171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist