Provider Demographics
NPI:1710090527
Name:GAN, MANJU P (MD)
Entity Type:Individual
Prefix:MRS
First Name:MANJU
Middle Name:P
Last Name:GAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:17800 TUSCAN DR
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-1093
Mailing Address - Country:US
Mailing Address - Phone:818-360-2935
Mailing Address - Fax:
Practice Address - Street 1:14445 OLIVE VIEW DR
Practice Address - Street 2:
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-1437
Practice Address - Country:US
Practice Address - Phone:818-364-4034
Practice Address - Fax:818-364-4537
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA42996207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G96317Medicare UPIN