Healthcare Provider Details

I. General information

NPI: 1205506979
Provider Name (Legal Business Name): SOO HYANG LIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25250 PACIFIC HWY S
KENT WA
98032-6539
US

IV. Provider business mailing address

5505 24TH ST NE
TACOMA WA
98422-3347
US

V. Phone/Fax

Practice location:
  • Phone: 253-946-7433
  • Fax:
Mailing address:
  • Phone: 503-970-0678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPH61180650
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: