Provider Demographics
NPI:1114028727
Name:GAN, TERESITA BELEN YAP (MD)
Entity Type:Individual
Prefix:
First Name:TERESITA BELEN
Middle Name:YAP
Last Name:GAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1433 W MERCED
Mailing Address - Street 2:STE 114-8
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-960-4989
Mailing Address - Fax:626-960-5520
Practice Address - Street 1:1433 W MERCED
Practice Address - Street 2:STE 114-8
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-960-4989
Practice Address - Fax:626-960-5520
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA036156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0013850Medicaid
W8065OtherGROUP MEDICARE
WA36516AMedicare ID - Type Unspecified
CAGR0013850Medicaid