Basic Information
| Provider Information | |||||||||
| NPI: | 1588169718 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIM | ||||||||
| FirstName: | CHANG HYUN | ||||||||
| MiddleName: | |||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5215 N CALIFORNIA AVE STE F603 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606258564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738783627 | ||||||||
| FaxNumber: | 7738780985 | ||||||||
| Practice Location | |||||||||
| Address1: | 5215 N CALIFORNIA AVE STE F603 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606258564 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738783627 | ||||||||
| FaxNumber: | 7738780985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2018 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036160839 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 125074409 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.