Provider Demographics
NPI:1285884395
Name:AH-KINE NG POON HING, DIANE (OD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:AH-KINE NG POON HING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 ARSENAL ST STE A
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2872
Mailing Address - Country:US
Mailing Address - Phone:617-336-7486
Mailing Address - Fax:
Practice Address - Street 1:204 ARSENAL ST
Practice Address - Street 2:STE A
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2781
Practice Address - Country:US
Practice Address - Phone:617-336-7486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110085225Medicaid