Provider Demographics
NPI:1831597590
Name:LIM, BOEY YEAN (LAC)
Entity type:Individual
Prefix:
First Name:BOEY
Middle Name:YEAN
Last Name:LIM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:MAY
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MACOM
Mailing Address - Street 1:5103 SE 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4107
Mailing Address - Country:US
Mailing Address - Phone:503-209-9802
Mailing Address - Fax:
Practice Address - Street 1:4629 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206
Practice Address - Country:US
Practice Address - Phone:503-209-9802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC170153171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist