Individual
DIANE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1981 E MAIN ST, WATERBURY, CT 06705-1853
(203) 709-5520
Mailing address
1980 E MAIN ST, WATERBURY, CT 06705-1815
(203) 709-5520
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
60506
CT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/03/2015
Last updated
11/23/2021
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