Healthcare Provider Details

I. General information

NPI: 1053860866
Provider Name (Legal Business Name): KEVIN MILES NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2016
Last Update Date: 08/06/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARNASSUS AVE
SAN FRANCISCO CA
94117-3608
US

IV. Provider business mailing address

350 PARNASSUS AVE
SAN FRANCISCO CA
94117-3608
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2119
  • Fax: 415-353-2406
Mailing address:
  • Phone: 415-353-2119
  • Fax: 415-353-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95004976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: