Individual
DR. DIANE M. KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2151 LEMOINE AVE., FORT LEE, NJ 07024
(201) 346-9000
(201) 346-9001
Mailing address
2151 LEMOINE AVE., FORT LEE, NJ 07024
(201) 346-9000
(201) 346-9001
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
270A00602800
NJ
152W00000X
Optometrist
TUV006818
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00244528
—
NY
05
—
0122874
—
NJ
Enumeration date
05/02/2006
Last updated
12/11/2014
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