Provider Demographics
NPI:1790194553
Name:LIM, JAHYUK JAY
Entity Type:Individual
Prefix:
First Name:JAHYUK
Middle Name:JAY
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 147TH ST
Mailing Address - Street 2:APT # 10-D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3765
Mailing Address - Country:US
Mailing Address - Phone:917-399-4386
Mailing Address - Fax:
Practice Address - Street 1:14843 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3330
Practice Address - Country:US
Practice Address - Phone:917-399-4386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019614225700000X
NY005371171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist