Provider Demographics
NPI:1770342842
Name:LIM, MIN S (FNP-C)
Entity type:Individual
Prefix:
First Name:MIN
Middle Name:S
Last Name:LIM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 COLORADO BLVD # 366
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1348
Mailing Address - Country:US
Mailing Address - Phone:310-345-6008
Mailing Address - Fax:
Practice Address - Street 1:2700 E CHAUCER ST UNIT 40
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-1844
Practice Address - Country:US
Practice Address - Phone:310-345-6008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily