Provider Demographics
NPI:1669806808
Name:LIM, YEE K (CPED)
Entity type:Individual
Prefix:
First Name:YEE
Middle Name:K
Last Name:LIM
Suffix:
Gender:F
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4815 W RUSSELL RD
Mailing Address - Street 2:STE 1A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-6241
Mailing Address - Country:US
Mailing Address - Phone:702-583-6192
Mailing Address - Fax:702-637-7691
Practice Address - Street 1:4815 W RUSSELL RD
Practice Address - Street 2:STE 1A
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-6241
Practice Address - Country:US
Practice Address - Phone:702-583-6192
Practice Address - Fax:702-637-7691
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
ID3389174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialist