Provider Demographics
NPI:1285511741
Name:KOO, ALAN JAY
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:JAY
Last Name:KOO
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 1:11965 LAMPLIGHTER LN
Mailing Address - Street 2:
Mailing Address - City:OAK HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92344-8688
Mailing Address - Country:US
Mailing Address - Phone:213-804-6054
Mailing Address - Fax:
Practice Address - Street 1:7977 SVL BOX
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5163
Practice Address - Country:US
Practice Address - Phone:213-804-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home