Diana Hyejung Kong, NP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

F381261 Issued in NY

Practice address

120 Mineola Blvd
Suite 210
Mineola, NY 11501-4064

Phone

(516) 663-4600

Fax

(516) 663-3826

NPI assigned

Sep 13, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Diana Hyejung Shim Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Networks

• Healthfirst Medicare Network H5989
• Healthfirst Medicare Network H3359
• Healthfirst Medicare Network H9678
• Healthfirst Medicare Network H1722

Interoperability endpoints

• Direct secure messaging: dkong677906@nychhc.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• MMC Pediatrics Faculty Practice

  • Pediatrics Physician
  • Brooklyn, NY
  • NPI 1285648154
  NPD (past)
• New York City Health and Hospitals Corporation

  • General Acute Care Hospital
  • Bronx, NY
  • NPI 1679587679
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329177600000",
    "number": "1841285152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 STATION PLZ N",
            "address_2": "SUITE 611",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013800",
            "telephone_number": "516-663-2532",
            "fax_number": "516-663-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MINEOLA BLVD",
            "address_2": "SUITE 210",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115014064",
            "telephone_number": "516-663-4600",
            "fax_number": "516-663-3826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONG",
        "first_name": "DIANA",
        "middle_name": "HYEJUNG",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-13",
        "last_updated": "2012-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NY",
            "license": "F381261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02160089",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANA",
            "last_name": "SHIM",
            "middle_name": "HYEJUNG",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Edward S. Koenig, PA
• Martin S. Kohn, MD
• Joseph Robert Koka, M.D.
• Katerina Kokkoris
• David Alan Kolins, DVM
• May W Kong, M.D.
• Stephanie Kong, DO
• Steven Eric Kong, MD
• Marlene Rachel Konner, MD
• Diana Kopach, DDS

• Pediatric Nurse Practitioner in Mineola, NY
• Providers in Mineola, NY by specialty
• Pediatric Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.