MEDICARE: DR. JOHN Y LIM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	194052	NY

General Provider Information

NPI Number	:	1215128814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN Y LIM MD

Provider Business Mailing Address
First Line	:	13640 39TH AVE
Second Line	:	SUITE 201
City	:	FLUSHING
State	:	NY
Zip	:	11354-5536
Country	:	US
Telephone Number	:	718-878-3457
Fax Number	:	718-878-4028

Provider Business Practice Location Address
First Line	:	13640 39TH AVE
Second Line	:	SUITE 201
City	:	FLUSHING
State	:	NY
Zip	:	11354-5536
Country	:	US
Telephone Number	:	718-878-3457
Fax Number	:	718-878-4028

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2007
Last Update Date	:	08/07/2007

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