Provider Demographics
NPI:1265693600
Name:LIM, PILSU
Entity type:Individual
Prefix:MR
First Name:PILSU
Middle Name:
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 1:445 N GAREY AVE
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5422
Mailing Address - Country:US
Mailing Address - Phone:909-623-5000
Mailing Address - Fax:
Practice Address - Street 1:445 N GAREY AVE
Practice Address - Street 2:SUITE 4A
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5422
Practice Address - Country:US
Practice Address - Phone:909-623-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12371171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist