Provider Demographics
NPI:1760742886
Name:LIM, DANIEL DAE (LAC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DAE
Last Name:LIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:DAE
Other - Middle Name:EUN
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4441 CALLE MAYOR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-378-8788
Mailing Address - Fax:310-579-6566
Practice Address - Street 1:4441 CALLE MAYOR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-378-8788
Practice Address - Fax:310-579-6566
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13593171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist