Provider Demographics
NPI:1477870699
Name:LIM, BYUNG SU (LAC)
Entity type:Individual
Prefix:MR
First Name:BYUNG SU
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 1:32020 1ST AVE S
Mailing Address - Street 2:SUITE#106
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5717
Mailing Address - Country:US
Mailing Address - Phone:253-874-3888
Mailing Address - Fax:
Practice Address - Street 1:32020 1ST AVE S
Practice Address - Street 2:SUITE#106
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5717
Practice Address - Country:US
Practice Address - Phone:253-874-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC60140972171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAC60140972OtherWA STATE LICENSE NUMBER