Provider Demographics
NPI:1740095678
Name:KIM, JOANNA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:KIM
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 S NEW MIDDLETOWN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5255
Mailing Address - Country:US
Mailing Address - Phone:610-872-8501
Mailing Address - Fax:
Practice Address - Street 1:176 S NEW MIDDLETOWN RD STE 101
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5255
Practice Address - Country:US
Practice Address - Phone:610-872-8501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant