Provider Demographics
NPI:1780648709
Name:KOE, KAREN E
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:KOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 LONG BEACH BLVD
Mailing Address - Street 2:230
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1531
Mailing Address - Country:US
Mailing Address - Phone:562-595-1961
Mailing Address - Fax:562-595-5351
Practice Address - Street 1:2840 LONG BEACH BLVD
Practice Address - Street 2:230
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1531
Practice Address - Country:US
Practice Address - Phone:562-595-1961
Practice Address - Fax:562-595-5351
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60896207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW385Medicare ID - Type Unspecified
CAE15055Medicare UPIN