Provider Demographics
NPI:1346230067
Name:LIM, CHANG SEIN (MD)
Entity Type:Individual
Prefix:
First Name:CHANG
Middle Name:SEIN
Last Name:LIM
Suffix:
Gender:M
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:PO BOX 750
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18501-0750
Mailing Address - Country:US
Mailing Address - Phone:570-346-7797
Mailing Address - Fax:570-342-9802
Practice Address - Street 1:601 PARK & WEST ST
Practice Address - Street 2:
Practice Address - City:HONESDALE
Practice Address - State:PA
Practice Address - Zip Code:18431
Practice Address - Country:US
Practice Address - Phone:570-253-1300
Practice Address - Fax:570-342-9802
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031615E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009962700001Medicaid
C28718Medicare UPIN
PA0009962700001Medicaid
PA065112EOQMedicare PIN