Individual
DIANE KIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
101 HOSPITAL RD, PATCHOGUE, NY 11772-4870
(631) 654-7100
Mailing address
32 ELTONA PL, EAST NORTHPORT, NY 11731-6012
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
25MP00996600
NJ
Other
Enumeration date
10/10/2022
Last updated
03/11/2026
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