Provider Demographics
NPI:1760487508
Name:LIM-KONG, MARIA B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:B
Last Name:LIM-KONG
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 1:2200 PHILADELPHIA DR
Mailing Address - Street 2:STE 101
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1830
Mailing Address - Country:US
Mailing Address - Phone:937-277-8988
Mailing Address - Fax:937-277-9360
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:STE 101
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1830
Practice Address - Country:US
Practice Address - Phone:937-277-8988
Practice Address - Fax:937-277-9360
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35037583L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0262862Medicaid
OHLI0429263Medicare ID - Type Unspecified
OH0262862Medicaid