MEDICARE: DR. MIA M BUSAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	38045	CA
2	122400000X	Denturist	38045	CA

General Provider Information

NPI Number	:	1801908298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIA M BUSAN DDS

Provider Business Mailing Address
First Line	:	12546 VALLEY VIEW ST
Second Line	:	B
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2006
Country	:	US
Telephone Number	:	714-895-4495
Fax Number	:

Provider Business Practice Location Address
First Line	:	12546 VALLEY VIEW ST
Second Line	:	B
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-2006
Country	:	US
Telephone Number	:	714-895-4495
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/11/2025

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