Provider Demographics
NPI:1336110048
Name:LIM-SOH, HYUN JIN (MD)
Entity Type:Individual
Prefix:MRS
First Name:HYUN
Middle Name:JIN
Last Name:LIM-SOH
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 1:290 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1945
Mailing Address - Country:US
Mailing Address - Phone:716-674-2393
Mailing Address - Fax:716-674-2460
Practice Address - Street 1:290 CENTER RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1945
Practice Address - Country:US
Practice Address - Phone:716-674-2393
Practice Address - Fax:716-674-2460
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169434207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010105101OtherUNIVERA
0809820OtherINDEPENDENT HEALTH
NY9434OtherEYE MED
0032484OtherGHI
NY01047185Medicaid
00050424009OtherALL BLUES PRODUCTS
NY9434OtherEYE MED
D01506Medicare UPIN