Provider Demographics
NPI:1821506775
Name:LIM, SOHYUN
Entity Type:Individual
Prefix:
First Name:SOHYUN
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 1:6084 ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3329
Mailing Address - Country:US
Mailing Address - Phone:310-415-4628
Mailing Address - Fax:
Practice Address - Street 1:18773 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748
Practice Address - Country:US
Practice Address - Phone:626-986-4899
Practice Address - Fax:626-986-4855
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55246363A00000X
CA55246363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant