Provider Demographics
NPI:1306041777
Name:GANGAL, KAANCHAN (MD)
Entity Type:Individual
Prefix:
First Name:KAANCHAN
Middle Name:
Last Name:GANGAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2228 NW PETTYGROVE ST STE 150
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2761
Mailing Address - Country:US
Mailing Address - Phone:503-288-5201
Mailing Address - Fax:
Practice Address - Street 1:2228 NW PETTYGROVE ST STE 150
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2761
Practice Address - Country:US
Practice Address - Phone:503-288-5201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1696962084S0012X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine