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1063202430 NPI number — SHANN LOUIS LIM

NPI Number: 1063202430
Health Care Provider/Practitioner: SHANN LOUIS LIM

Information about “1063202430” NPI (SHANN LOUIS LIM) exists in 1063202430 in HTML format HTML  |  1063202430 in plain Text format TXT  |  1063202430 in PDF (Portable Document Format) PDF  |  1063202430 in an XML format XML  formats.

NPI Number : 1063202430 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063202430",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LIM",
    "FirstName": "SHANN LOUIS",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2139 RANCH VIEW DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROCKLIN",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95765-5357",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "805-407-6192",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8303 SIERRA COLLEGE BLVD STE 146",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GRANITE BAY",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95661-9419",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "916-746-7235",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/08/2025",
    "LastUpdateDate": "05/08/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101Y00000X",
        "TaxonomyName": "Counselor",
        "LicenseNumber": "APCC16961",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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