Darron Ikari Miya

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

104627 Issued in CA

Practice address

159 W Hospitality LN
San Bernardino, CA 92408-3348

Phone

(909) 558-4616

NPI assigned

Aug 18, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599696000000",
    "number": "1114539442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "828 MALONE DR",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906402424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "159 W HOSPITALITY LN",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083348",
            "telephone_number": "909-558-4616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIYA",
        "first_name": "DARRON",
        "middle_name": "IKARI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-18",
        "last_updated": "2020-09-10",
        "certification_date": "2020-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "104627",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA DENTAL BOARD",
            "identifier": "104627",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dmiya@llu.edu",
            "affiliation": "N",
            "address_1": "159 W Hospitality Ln",
            "city": "San Bernardino",
            "state": "CA",
            "country_code": "US",
            "postal_code": "924083348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Ashley M Mitchell, B.A.
• Gregory N Mitchell, PA-C
• Joanne Mitchell
• Kareka Mitchell
• Jeannine Mitterholzer
• Lee Miyauchi, DDS
• Victor Sameer Mniarji, MD
• Andrea Julia Mobilia, DDS
• Terrance Allen Mock, MFT
• Ladan Modallel, MD

• Orthodontics and Dentofacial Orthopedics Dentistry in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.