Provider Demographics
NPI:1841692407
Name:LIM, MIYOUNG
Entity type:Individual
Prefix:
First Name:MIYOUNG
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 1:4936 ANGELES CREST HWY
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2314
Mailing Address - Country:US
Mailing Address - Phone:213-446-3046
Mailing Address - Fax:818-864-6021
Practice Address - Street 1:4936 ANGELES CREST HWY
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2314
Practice Address - Country:US
Practice Address - Phone:213-446-3046
Practice Address - Fax:818-864-6021
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 620860163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse