Provider Demographics
NPI:1710654140
Name:GAN, QUAN
Entity Type:Individual
Prefix:
First Name:QUAN
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 1:950 WOODSIDE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3643
Mailing Address - Country:US
Mailing Address - Phone:510-857-4811
Mailing Address - Fax:
Practice Address - Street 1:950 WOODSIDE RD STE 2
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3643
Practice Address - Country:US
Practice Address - Phone:650-257-7943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2023-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19209171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist