Provider Demographics
NPI:1255923348
Name:LIM, BYUNG CHAN (LAC)
Entity type:Individual
Prefix:MR
First Name:BYUNG CHAN
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 N SAN DIMAS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2658
Mailing Address - Country:US
Mailing Address - Phone:909-837-0552
Mailing Address - Fax:
Practice Address - Street 1:319 N SAN DIMAS AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2658
Practice Address - Country:US
Practice Address - Phone:909-837-0552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14669171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist