Basic Information
Provider Information
NPI: 1003003294
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIM
FirstName: ERICA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3416 1/2 WALTON AVE
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900073452
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3751 STOCKER ST
Address2:  
City: LOS ANGELES
State: CA
PostalCode: 900085101
CountryCode: US
TelephoneNumber: 3232983680
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/01/2007
LastUpdateDate: 10/01/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
390200000X  Y Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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