Provider Demographics
NPI:1265792477
Name:KIM, TASHA M (PA)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:M
Last Name:KIM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3439 GRANITE CIR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1161
Mailing Address - Country:US
Mailing Address - Phone:419-843-7996
Mailing Address - Fax:419-841-7725
Practice Address - Street 1:3439 GRANITE CIR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1161
Practice Address - Country:US
Practice Address - Phone:419-843-7996
Practice Address - Fax:419-841-7725
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50.003503363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant