Physician Compare National (NPI:1073537817)

HEALTHCARE PROVIDER: KENNETH JOEL MILLER MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1073537817
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	5496792962
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100827000270
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MILLER
	Individual professional last name
Provider First Name	KENNETH
	Individual professional first name
Provider Middle Name	JOEL
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	ST. LOUIS COLLEGE OF PHYSICIANS AND SURGEONS
	Individual professional's medical school
Graduation Year	1967
	Individual professional's medical school graduation year
Primary Specialty	OPHTHALMOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	KENNETH J MILLER MD A MEDICAL CORP
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	9234166695
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1360 W 6TH ST
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 215
	Group Practice or individual's line 2 address
City	SAN PEDRO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	907323562
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3105479991
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y