Provider Demographics
NPI:1548617921
Name:LIM, WON SEOK
Entity type:Individual
Prefix:
First Name:WON SEOK
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 SANTA ROSALIA DR # 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-3627
Mailing Address - Country:US
Mailing Address - Phone:323-295-3194
Mailing Address - Fax:323-295-3270
Practice Address - Street 1:3750 SANTA ROSALIA DR # 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-3627
Practice Address - Country:US
Practice Address - Phone:323-295-3194
Practice Address - Fax:323-295-3270
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56887183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist