Provider Demographics
NPI:1154475655
Name:DIAKUN, JOHN LOUIS (MS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LOUIS
Last Name:DIAKUN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 NEW BRITAIN RD
Mailing Address - Street 2:SUITE #108
Mailing Address - City:KENSINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06037-1360
Mailing Address - Country:US
Mailing Address - Phone:860-826-6450
Mailing Address - Fax:860-826-6451
Practice Address - Street 1:211 NEW BRITAIN RD
Practice Address - Street 2:SUITE #108
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-1360
Practice Address - Country:US
Practice Address - Phone:860-826-6450
Practice Address - Fax:860-826-6451
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000103237700000X
CT000075231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004015038Medicaid
CT004035143Medicaid