NPIMap

Individual provider Active NPI

Andrew Jon Kimitsuka, PA-C

  • Surgical Physician Assistant
  • Tacoma, WA
National Provider Identifier
1518754837
Registry record updated Sep 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA.PA.61633154 Issued in WA
Practice address
1608 S J St FL 5
Tacoma, WA 98405-4930
Phone
(253) 274-7505
Fax
(253) 274-7948
NPI assigned
Apr 21, 2025
Last updated
Sep 25, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.PA.61633154 WA
Surgical Physician Assistant 363AS0400X PA.PA.61633154 WA Primary

Addresses

Primary practice location

1608 S J St FL 5
Tacoma, WA 98405-4930

Mailing address

1608 S J St FL 5
Tacoma, WA 98405-4930
Phone (253) 274-7505

Other practice location 1

3920 Capital Mall Dr SW Ste 100
Olympia, WA 98502-8701
Phone (360) 706-6250

Other identifiers 1

IdentifierTypeStateIssuer
2337343MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250801000003 WA Practitioner - Physician Assistant 0446768519 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Capital Medical Center Specialty Physicians LLCGroup PAC ID 2567651771, 103 clinicians

Practice addresses (Care Compare)

3900 Capital Mall Dr SW
Olympia, WA 98502-8654
Phone (360) 704-4743

3920 Capital Mall Dr SW
Olympia, WA 98502-8701

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA61633154WAMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: akimitsuka846689@direct.multicare.org

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790294400000",
    "number": "1518754837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1608 S J ST FL 5",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054930",
            "telephone_number": "253-274-7505",
            "fax_number": "253-274-7948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1608 S J ST FL 5",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984054930",
            "telephone_number": "253-274-7505",
            "fax_number": "253-274-7948"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3920 Capital Mall Dr SW Ste 100",
            "address_purpose": "LOCATION",
            "city": "Olympia",
            "state": "WA",
            "postal_code": "985028701",
            "country_code": "US",
            "telephone_number": "360-706-6250",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIMITSUKA",
        "first_name": "ANDREW",
        "middle_name": "JON",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-21",
        "last_updated": "2026-09-25",
        "certification_date": "2026-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA.PA.61633154",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA.PA.61633154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2337343",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.