Provider Demographics
NPI:1750490520
Name:KLOBY, JAY (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:KLOBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S 320TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4691
Mailing Address - Country:US
Mailing Address - Phone:253-839-8779
Mailing Address - Fax:253-941-6941
Practice Address - Street 1:700 S 320TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4691
Practice Address - Country:US
Practice Address - Phone:253-839-8779
Practice Address - Fax:253-941-6941
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000304782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7117252Medicaid
WA8233041Medicaid
WAGAB38776Medicare PIN
WAAB38777Medicare PIN
WA7117252Medicaid