Provider Demographics
NPI:1033142716
Name:LIM, CHESTER WONG (OD)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:WONG
Last Name:LIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 CLEMENT ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-2407
Mailing Address - Country:US
Mailing Address - Phone:415-221-3342
Mailing Address - Fax:
Practice Address - Street 1:235 CLEMENT ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2407
Practice Address - Country:US
Practice Address - Phone:415-221-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5731152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0057310Medicaid
CA0968730001Medicare ID - Type Unspecified
CASD0057310Medicaid