Provider Demographics
NPI:1346560547
Name:MILLER AND KAN, A PROFESSIONAL DENTAL CORPORATION
Entity Type:Organization
Organization Name:MILLER AND KAN, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:MILLER AND KAN ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-427-1426
Mailing Address - Street 1:4301 ATLANTIC AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2833
Mailing Address - Country:US
Mailing Address - Phone:562-427-1426
Mailing Address - Fax:562-427-4406
Practice Address - Street 1:4301 ATLANTIC AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2833
Practice Address - Country:US
Practice Address - Phone:562-427-1426
Practice Address - Fax:562-427-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556991223X0400X
CA530021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1083800783OtherNPI TYPE 1
1194975458OtherNPI TYPE 1