Healthcare Provider Details

I. General information

NPI: 1770681165
Provider Name (Legal Business Name): MISS SANG-SUK REGINA LIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 S GRAND AVE
LOS ANGELES CA
90007-3304
US

IV. Provider business mailing address

2829 S GRAND AVE
LOS ANGELES CA
90007-3304
US

V. Phone/Fax

Practice location:
  • Phone: 213-744-3734
  • Fax: 213-765-0537
Mailing address:
  • Phone: 213-744-3945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP364081
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: