Provider Demographics
NPI:1447727433
Name:LIM, TAE HYOUNG (LAC)
Entity type:Individual
Prefix:
First Name:TAE HYOUNG
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 LINWOOD PLZ STE 304
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3766
Mailing Address - Country:US
Mailing Address - Phone:551-244-5803
Mailing Address - Fax:
Practice Address - Street 1:158 LINWOOD PLZ STE 304
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3766
Practice Address - Country:US
Practice Address - Phone:551-244-5803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-27
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00638801171100000X
NJ25MZ00160000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist