Individual
DR. DIANA KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
3130 E MAIN ST STE 200, MOHEGAN LAKE, NY 10547-1517
(845) 284-6296
Mailing address
3753 MERMAID AVE APT 2, BROOKLYN, NY 11224-1274
(646) 330-2756
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
063195
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/28/2022
Last updated
08/04/2023
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