Provider Demographics
NPI:1558571828
Name:FAN, YAN GAO (MD)
Entity Type:Individual
Prefix:DR
First Name:YAN
Middle Name:GAO
Last Name:FAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:YAN
Other - Middle Name:
Other - Last Name:GAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:481 EDWARD H ROSS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407
Mailing Address - Country:US
Mailing Address - Phone:800-627-1479
Mailing Address - Fax:
Practice Address - Street 1:481 EDWARD H ROSS DRIVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407
Practice Address - Country:US
Practice Address - Phone:800-627-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040589207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology