Provider Demographics
NPI:1659341485
Name:GAN, LUISA Y (MD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:Y
Last Name:GAN
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 1:5308 NORTH GALLOWAY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150
Mailing Address - Country:US
Mailing Address - Phone:972-226-0505
Mailing Address - Fax:972-289-9640
Practice Address - Street 1:5308 N GALLOWAY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1122
Practice Address - Country:US
Practice Address - Phone:972-226-0505
Practice Address - Fax:972-289-9640
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6780207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C15866Medicare UPIN