Provider Demographics
NPI:1144264763
Name:WONG, LIM W (MD)
Entity type:Individual
Prefix:DR
First Name:LIM
Middle Name:W
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:833 CHESTNUT ST
Mailing Address - Street 2:SUITE 701
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4409
Mailing Address - Country:US
Mailing Address - Phone:215-955-0735
Mailing Address - Fax:215-503-9239
Practice Address - Street 1:833 CHESTNUT ST
Practice Address - Street 2:SUITE 701
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4409
Practice Address - Country:US
Practice Address - Phone:215-955-0735
Practice Address - Fax:215-503-9239
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-04-14
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Provider Licenses
StateLicense IDTaxonomies
PAMD062392L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016472000002Medicaid
PA908516Medicare PIN
PAG49132Medicare UPIN
PAG49132Medicare UPIN