MEDICARE: GLENN YUKIO MIYA MD

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	208000000X	Pediatrics Physician	G70876	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912967894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN YUKIO MIYA MD

Provider Business Mailing Address
First Line	:	840 TOWNE CENTER DR
Second Line	:	CHAPARRAL MEDICAL GROUP
City	:	POMONA
State	:	CA
Zip	:	91767-5900
Country	:	US
Telephone Number	:	909-398-1550
Fax Number	:	909-398-1573

Provider Business Practice Location Address
First Line	:	430 W BASELINE RD
Second Line	:
City	:	CLAREMONT
State	:	CA
Zip	:	91711-1607
Country	:	US
Telephone Number	:	909-621-3916
Fax Number	:	909-625-0903

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	12/03/2021

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Directions to “ GLENN YUKIO MIYA MD” Practice Location

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