Provider Demographics
NPI:1215216221
Name:YERN, GAN
Entity Type:Individual
Prefix:MR
First Name:GAN
Middle Name:
Last Name:YERN
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 1:2201 S COMMONS
Mailing Address - Street 2:T1947
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6023
Mailing Address - Country:US
Mailing Address - Phone:253-733-7521
Mailing Address - Fax:
Practice Address - Street 1:2201 S COMMONS
Practice Address - Street 2:T1947
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6023
Practice Address - Country:US
Practice Address - Phone:253-733-7521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-08
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60231072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist