Provider Demographics
NPI:1215141635
Name:LIM, JIN KYOU (LAC)
Entity type:Individual
Prefix:
First Name:JIN KYOU
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:12600 HESPERIA RD
Mailing Address - Street 2:#G
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-5899
Mailing Address - Country:US
Mailing Address - Phone:760-241-4600
Mailing Address - Fax:760-495-3105
Practice Address - Street 1:12600 HESPERIA RD
Practice Address - Street 2:#G
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5899
Practice Address - Country:US
Practice Address - Phone:760-241-4600
Practice Address - Fax:760-495-3105
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2011-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC 10297171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist