Provider Demographics
NPI:1093804411
Name:LIM, BYUNG S (MD)
Entity Type:Individual
Prefix:DR
First Name:BYUNG
Middle Name:S
Last Name:LIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:14 HOSPITAL DR
Mailing Address - Street 2:PO BOX 606
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1019
Mailing Address - Country:US
Mailing Address - Phone:213-769-6081
Mailing Address - Fax:315-769-1733
Practice Address - Street 1:14 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1019
Practice Address - Country:US
Practice Address - Phone:213-769-6081
Practice Address - Fax:315-769-1733
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY113567208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00206666Medicaid
NY32072BMedicare ID - Type Unspecified
NY00206666Medicaid