Provider Demographics
NPI:1083667208
Name:LIM, JUDY MI-YOUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:MI-YOUNG
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 E MAIN STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7128
Mailing Address - Country:US
Mailing Address - Phone:302-366-0550
Mailing Address - Fax:302-633-1375
Practice Address - Street 1:314 E MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711
Practice Address - Country:US
Practice Address - Phone:023-663-0550
Practice Address - Fax:302-366-8905
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007496207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039778Medicaid
DE1000039778Medicaid
021574T76Medicare PIN