Provider Demographics
NPI:1790346690
Name:LIM, JAMES JONG SOO (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JONG SOO
Last Name:LIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3345 WILSHIRE BLVD APT 613
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1817
Mailing Address - Country:US
Mailing Address - Phone:808-265-2023
Mailing Address - Fax:
Practice Address - Street 1:303 S LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3526
Practice Address - Country:US
Practice Address - Phone:323-634-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA81036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist