Provider Demographics
NPI:1063473064
Name:LIM, OONA (MD)
Entity Type:Individual
Prefix:
First Name:OONA
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 CLINTON AVE S
Mailing Address - Street 2:SUITE 610
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5720
Mailing Address - Country:US
Mailing Address - Phone:585-244-3430
Mailing Address - Fax:
Practice Address - Street 1:1815 S CLINTON AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5720
Practice Address - Country:US
Practice Address - Phone:585-244-3430
Practice Address - Fax:585-244-7811
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206525207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000920787003OtherBC/BS OF WESTERN NEW YORK
NY01955715Medicaid
NY000920787002OtherBC/BS OF WESTERN NEW YORK
NY000920787001OtherBC/BS OF WESTERN NEW YORK
NY106652751OtherRAILROAD
NY5996397OtherGHI
NY102925CKOtherPREFERRED CARE
NYP010206525OtherBLUE CHOICE
NY7575228OtherAETNA
NYP010206525OtherBC/BS
NY000920787003OtherBC/BS OF WESTERN NEW YORK
NYG97037Medicare UPIN