Provider Demographics
NPI:1942744719
Name:LIM, SEUNG TAEK (AGNP-C)
Entity Type:Individual
Prefix:
First Name:SEUNG TAEK
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8949 GAYLORD DRIVE
Mailing Address - Street 2:APT #242
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2921
Mailing Address - Country:US
Mailing Address - Phone:832-369-2372
Mailing Address - Fax:
Practice Address - Street 1:264 FARM TO MARKET 3478
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77320-3320
Practice Address - Country:US
Practice Address - Phone:936-291-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131968363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology