MEDICARE: CHANG HYUN LIM DO

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	207Q00000X	Family Medicine Physician	036160839	IL
2	207Q00000X	Family Medicine Physician	125074409	IL
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1588169718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANG HYUN LIM DO

Provider Business Mailing Address
First Line	:	5215 N CALIFORNIA AVE STE F603
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-8564
Country	:	US
Telephone Number	:	773-878-3627
Fax Number	:	773-878-0985

Provider Business Practice Location Address
First Line	:	5215 N CALIFORNIA AVE STE F603
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-8564
Country	:	US
Telephone Number	:	773-878-3627
Fax Number	:	773-878-0985

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

Provider Enumeration Date	:	03/29/2018
Last Update Date	:	07/18/2022

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