Provider Demographics
NPI:1528291648
Name:LIM, SU
Entity type:Individual
Prefix:MS
First Name:SU
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 1:848 5TH ST
Mailing Address - Street 2:APT 10
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1357
Mailing Address - Country:US
Mailing Address - Phone:310-880-9199
Mailing Address - Fax:
Practice Address - Street 1:848 5TH ST
Practice Address - Street 2:APT 10
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1357
Practice Address - Country:US
Practice Address - Phone:310-880-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program