Provider Demographics
NPI:1518415975
Name:LIM, BAN HONG (PHD)
Entity type:Individual
Prefix:DR
First Name:BAN HONG
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PHYLICE
Other - Middle Name:
Other - Last Name:LIM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:13131 PARK PLACE UNIT 104
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250
Mailing Address - Country:US
Mailing Address - Phone:785-312-4077
Mailing Address - Fax:
Practice Address - Street 1:221 WESTWOOD PLAZA
Practice Address - Street 2:BOX 951556
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-825-0768
Practice Address - Fax:310-206-7365
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY29590103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist