Provider Demographics
NPI:1700690054
Name:JAY, KOE KAH
Entity type:Individual
Prefix:
First Name:KOE KAH
Middle Name:
Last Name:JAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 W GOODWIN CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68524-2108
Mailing Address - Country:US
Mailing Address - Phone:402-802-3341
Mailing Address - Fax:
Practice Address - Street 1:5310 W GOODWIN CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68524-2108
Practice Address - Country:US
Practice Address - Phone:402-802-3341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-06
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant