Provider Demographics
NPI:1609810787
Name:MILLER, KENNETH AMES (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:AMES
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14527 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2003
Mailing Address - Country:US
Mailing Address - Phone:408-356-9111
Mailing Address - Fax:408-356-9113
Practice Address - Street 1:14527 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2003
Practice Address - Country:US
Practice Address - Phone:408-356-9111
Practice Address - Fax:408-356-9113
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22330207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G223301Medicare PIN
CAA41543Medicare UPIN