Provider Demographics
NPI:1215128814
Name:LIM, JOHN Y (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:Y
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 39TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5536
Mailing Address - Country:US
Mailing Address - Phone:718-878-3457
Mailing Address - Fax:718-878-4028
Practice Address - Street 1:13640 39TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5536
Practice Address - Country:US
Practice Address - Phone:718-878-3457
Practice Address - Fax:718-878-4028
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194052208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice