Provider Demographics
NPI:1265736060
Name:LIM, EUN JOO (LAC)
Entity type:Individual
Prefix:MISS
First Name:EUN JOO
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 W 6TH ST
Mailing Address - Street 2:6F #604
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-2537
Mailing Address - Country:US
Mailing Address - Phone:213-500-7738
Mailing Address - Fax:
Practice Address - Street 1:3407 W 6TH ST
Practice Address - Street 2:6F #604
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2537
Practice Address - Country:US
Practice Address - Phone:213-500-7738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13402171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC13402OtherACUPUNCTURE