Provider Demographics
NPI:1568698561
Name:GAN, GREGORY (MD, PHD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:GAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-8504
Mailing Address - Country:US
Mailing Address - Phone:913-588-3600
Mailing Address - Fax:913-588-3663
Practice Address - Street 1:4001 RAINBOW BLVD # MS 4001
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160-4374
Practice Address - Country:US
Practice Address - Phone:913-588-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-422042085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology