Provider Demographics
NPI:1568922326
Name:LIM, AARON TUNGYIN
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:TUNGYIN
Last Name:LIM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 NICOLLS ROAD
Mailing Address - Street 2:HSC, L-4, RM 050
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-1859
Mailing Address - Country:US
Mailing Address - Phone:631-444-2465
Mailing Address - Fax:
Practice Address - Street 1:101 NICOLLS ROAD
Practice Address - Street 2:HSC, L-4, RM 050
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-1859
Practice Address - Country:US
Practice Address - Phone:631-444-2465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY320911207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program