Provider Demographics
NPI:1477673416
Name:MILLER, MILON JOHN HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MILON JOHN
Middle Name:HOWARD
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 AMESBURY RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1305
Mailing Address - Country:US
Mailing Address - Phone:323-663-4121
Mailing Address - Fax:323-663-4121
Practice Address - Street 1:3711 AMESBURY RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-1305
Practice Address - Country:US
Practice Address - Phone:323-663-4121
Practice Address - Fax:323-663-4121
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30727174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG58219Medicare UPIN