Provider Demographics
NPI:1548205248
Name:GAN, YANJUN (DDS)
Entity Type:Individual
Prefix:
First Name:YANJUN
Middle Name:
Last Name:GAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 156TH AVE NE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4344
Mailing Address - Country:US
Mailing Address - Phone:425-614-1098
Mailing Address - Fax:425-614-1139
Practice Address - Street 1:1811 156TH AVE NE
Practice Address - Street 2:SUITE 3
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4344
Practice Address - Country:US
Practice Address - Phone:425-614-1098
Practice Address - Fax:425-614-1139
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000098241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice