Provider Demographics
NPI:1336408772
Name:LIM, NAYOUNG
Entity Type:Individual
Prefix:
First Name:NAYOUNG
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 1:10760 MAPLE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55129-8320
Mailing Address - Country:US
Mailing Address - Phone:651-707-3026
Mailing Address - Fax:
Practice Address - Street 1:1612 COMO AVE STE B2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-2718
Practice Address - Country:US
Practice Address - Phone:651-707-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1606171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN54850925OtherHEALTHPARTNERS