Provider Demographics
NPI:1487529061
Name:KIDD, KASHIRA (RA)
Entity type:Individual
Prefix:MS
First Name:KASHIRA
Middle Name:
Last Name:KIDD
Suffix:
Gender:F
Credentials:RA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7829 S SAGINAW AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-5221
Mailing Address - Country:US
Mailing Address - Phone:301-877-4769
Mailing Address - Fax:
Practice Address - Street 1:7503 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3358
Practice Address - Country:US
Practice Address - Phone:301-877-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-06
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDK0000016243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner AssistantGroup - Single Specialty