MEDICARE: HYUNG MIN 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	207RN0300X	Nephrology Physician	D0046907	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54234901	OTHER	MD	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760480164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYUNG MIN LIM M.D.

Provider Business Mailing Address
First Line	:	5601 LOCH RAVEN BLVD
Second Line	:	STE 3
City	:	BALTIMORE
State	:	MD
Zip	:	21239-2905
Country	:	US
Telephone Number	:	443-444-3775
Fax Number	:	443-444-4678

Provider Business Practice Location Address
First Line	:	520 UPPER CHESAPEAKE DR
Second Line	:	STE 312
City	:	BEL AIR
State	:	MD
Zip	:	21014-4463
Country	:	US
Telephone Number	:	443-444-3775
Fax Number	:	443-444-4678

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	05/19/2010

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