Provider Demographics
NPI:1124390810
Name:BYUNG S. LIM , MD, PC
Entity Type:Organization
Organization Name:BYUNG S. LIM , MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAIPO
Authorized Official - Middle Name:
Authorized Official - Last Name:R
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-769-6081
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-0606
Mailing Address - Country:US
Mailing Address - Phone:315-769-6081
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:315-769-6081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113567208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY206666Medicaid
NYJ400066065Medicare PIN
NY206666Medicaid