Provider Demographics
NPI:1588169718
Name:LIM, CHANG HYUN (DO)
Entity type:Individual
Prefix:
First Name:CHANG HYUN
Middle Name:
Last Name:LIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 N CALIFORNIA AVE STE F603
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-8564
Mailing Address - Country:US
Mailing Address - Phone:773-878-3627
Mailing Address - Fax:773-878-0985
Practice Address - Street 1:5215 N CALIFORNIA AVE STE F603
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-8564
Practice Address - Country:US
Practice Address - Phone:773-878-3627
Practice Address - Fax:773-878-0985
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036160839207Q00000X
IL125074409207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program