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1336012012 NPI number — TAE KEUN LIM PHARM D

NPI Number: 1336012012
Health Care Provider/Practitioner: TAE KEUN LIM PHARM D

Information about “1336012012” NPI (TAE KEUN LIM PHARM D) exists in 1336012012 in HTML format HTML  |  1336012012 in plain Text format TXT  |  1336012012 in PDF (Portable Document Format) PDF  |  1336012012 in an XML format XML  formats.

NPI Number : 1336012012 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336012012",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LIM",
    "FirstName": "TAE",
    "MiddleName": "KEUN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARM D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LIM",
    "OtherFirstName": "TAE KEUN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PHARM D",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "235 W VAN BUREN ST UNIT 1502",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60607-3926",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1500 S FAIRFIELD AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60608-1782",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "773-542-2000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/29/2025",
    "LastUpdateDate": "09/29/2025",
    "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": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "051303228",
        "LicenseNumberStateCode": "IL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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