Provider Demographics
NPI:1851302616
Name:LIM, VIVIEN (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:VIVIEN
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4503 KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3429
Mailing Address - Country:US
Mailing Address - Phone:646-494-7281
Mailing Address - Fax:877-249-6926
Practice Address - Street 1:4503 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3429
Practice Address - Country:US
Practice Address - Phone:646-494-7281
Practice Address - Fax:877-249-6926
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235491174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02694879Medicaid
NY02694879Medicaid