Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Diane Kim

Individual provider Physician Assistant · NPI 1922723279

Diane Kim is a Physician Assistant in Patchogue, New York. Qualified in 2022, 4 years ago. Practices with Summit Medical Group PA, a 1,205-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in New Jersey.

Years since qualifying
4
Licensed in
NJ
In the registry since
2022
Specialties on file
2
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Practice location Address checks out

101 Hospital Rd
Patchogue, NY 11772-4870
Phone: (631) 654-7100
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1 Diamond Hill Rd, Berkeley Heights, NJ 07922-2104 — (516) 783-4600

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X
Medical Physician Assistant Taxonomy 363AM0700X · Licence 25MP00996600 (NJ)

Record details

NPI number1922723279
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 10, 2022
Last updated in NPPESMarch 11, 2026
Certification dateMarch 11, 2026
Mailing address32 Eltona Pl, East Northport, NY 11731-6012

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Summit Medical Group Pa — 1205 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

Other providers in Patchogue