Provider Demographics
NPI:1659758936
Name:GAN, YEE VON
Entity Type:Individual
Prefix:
First Name:YEE VON
Middle Name:
Last Name:GAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 GEORGIA AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5020
Mailing Address - Country:US
Mailing Address - Phone:301-990-1664
Mailing Address - Fax:301-990-0471
Practice Address - Street 1:10301 GEORGIA AVE STE 106
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5020
Practice Address - Country:US
Practice Address - Phone:301-990-1664
Practice Address - Fax:301-990-0471
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-06
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008260-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered