Provider Demographics
NPI:1992767925
Name:LIM, VINCENT JANG (ATC,CEAS)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:JANG
Last Name:LIM
Suffix:
Gender:M
Credentials:ATC,CEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4074
Mailing Address - Country:US
Mailing Address - Phone:773-205-8715
Mailing Address - Fax:
Practice Address - Street 1:4750 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4074
Practice Address - Country:US
Practice Address - Phone:773-205-8715
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer