MEDICARE: DR. KONGSEH LIM M.D.

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	207L00000X	Anesthesiology Physician	A128659-1	NY

General Provider Information

NPI Number	:	1255333795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KONGSEH LIM M.D.

Provider Business Mailing Address
First Line	:	PO BOX 650457
Second Line	:
City	:	FRESH MEADOWS
State	:	NY
Zip	:	11365-0457
Country	:	US
Telephone Number	:	800-875-4886
Fax Number	:

Provider Business Practice Location Address
First Line	:	327 BEACH 19TH ST
Second Line	:	ST. JOHN'S EPISCOPAL HOSPITAL
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4423
Country	:	US
Telephone Number	:	718-869-7212
Fax Number	:

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	07/08/2007

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