Provider Demographics
NPI:1750370060
Name:MILLER, KATHERINE VANDOREEN (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:VANDOREEN
Last Name:MILLER
Suffix:
Gender:F
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 1:3333 SKYPARK DR
Mailing Address - Street 2:STE 240
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5023
Mailing Address - Country:US
Mailing Address - Phone:310-257-5797
Mailing Address - Fax:310-257-5798
Practice Address - Street 1:3333 SKYPARK DR
Practice Address - Street 2:STE 240
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5023
Practice Address - Country:US
Practice Address - Phone:310-257-5797
Practice Address - Fax:310-257-5798
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA54973207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A54973Medicare ID - Type Unspecified
G70598Medicare UPIN