Provider Demographics
NPI:1609861079
Name:MILLER, KIMIKO P (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KIMIKO
Middle Name:P
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 SNOWFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-4662
Mailing Address - Country:US
Mailing Address - Phone:714-743-2722
Mailing Address - Fax:714-524-6007
Practice Address - Street 1:1275 N ROSE DR STE 106
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3945
Practice Address - Country:US
Practice Address - Phone:714-572-1921
Practice Address - Fax:714-572-8334
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA-11833363AM0700X
CAPA11833363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA11833HMedicare PIN