Provider Demographics
NPI:1316272446
Name:LIM, MARY HYO (L AC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:HYO
Last Name:LIM
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66313 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-3960
Mailing Address - Country:US
Mailing Address - Phone:760-668-4567
Mailing Address - Fax:
Practice Address - Street 1:66313 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-3960
Practice Address - Country:US
Practice Address - Phone:760-668-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9561171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist