Healthcare Provider Details

I. General information

NPI: 1124390810
Provider Name (Legal Business Name): BYUNG S. LIM , MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 10/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 HOSPITAL DR
MASSENA NY
13662-1019
US

IV. Provider business mailing address

PO BOX 606
MASSENA NY
13662-0606
US

V. Phone/Fax

Practice location:
  • Phone: 315-769-6081
  • Fax:
Mailing address:
  • Phone: 315-769-6081
  • Fax: 315-769-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number113567
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number113567
License Number StateNY

VIII. Authorized Official

Name: MRS. KAIPO R
Title or Position: OFFICE MANAGER
Credential:
Phone: 315-769-6081