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NPI Code Detail

MEDICARE: JOANNA KIM PHYSICIAN ASSISTANT

MEDICARE: JOANNA KIM PHYSICIAN ASSISTANT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantMA066336PA

General Provider Information

NPI Number : 1740095678
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNA KIM PHYSICIAN ASSISTANT
Provider Business Mailing Address
First Line : 176 S NEW MIDDLETOWN RD STE 101
Second Line :
City : MEDIA
State : PA
Zip : 19063-5255
Country : US
Telephone Number : 610-872-8501
Fax Number :
Provider Business Practice Location Address
First Line : 176 S NEW MIDDLETOWN RD STE 101
Second Line :
City : MEDIA
State : PA
Zip : 19063-5255
Country : US
Telephone Number : 610-872-8501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2025
Last Update Date : 03/02/2026

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Directions to “ JOANNA KIM PHYSICIAN ASSISTANT” Practice Location

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