Provider Demographics
NPI:1124607924
Name:LIM, SHARON (CNS)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 REMY JAVIER CT
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7991
Mailing Address - Country:US
Mailing Address - Phone:408-905-6052
Mailing Address - Fax:
Practice Address - Street 1:2514 GLEN DUNDEE WAY
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-4134
Practice Address - Country:US
Practice Address - Phone:408-905-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18041133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist