Provider Demographics
NPI:1447063771
Name:KYAW, MICHAEL MOO
Entity type:Individual
Prefix:
First Name:MICHAEL MOO
Middle Name:
Last Name:KYAW
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 1:2414 N 45TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-4511
Mailing Address - Country:US
Mailing Address - Phone:402-516-5004
Mailing Address - Fax:
Practice Address - Street 1:2414 N 45TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-4511
Practice Address - Country:US
Practice Address - Phone:402-515-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant