Provider Demographics
NPI:1679593677
Name:GAN, JUNYAN (OD)
Entity Type:Individual
Prefix:
First Name:JUNYAN
Middle Name:
Last Name:GAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:GAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:5335 NE 4TH ST
Mailing Address - Street 2:STE 4
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4831
Mailing Address - Country:US
Mailing Address - Phone:425-282-5475
Mailing Address - Fax:
Practice Address - Street 1:5335 NE 4TH ST STE 4
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-4831
Practice Address - Country:US
Practice Address - Phone:425-282-5475
Practice Address - Fax:425-282-5936
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3813152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU97909Medicare UPIN
WA8803855Medicare ID - Type Unspecified