Provider Demographics
NPI:1942606165
Name:JUN, DIANA (NP-C)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:JUN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 E 60TH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1008
Mailing Address - Country:US
Mailing Address - Phone:917-580-6344
Mailing Address - Fax:
Practice Address - Street 1:30 E 60TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1008
Practice Address - Country:US
Practice Address - Phone:917-580-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-16
Last Update Date:2014-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307134-1363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology