Provider Demographics
NPI:1972769768
Name:GAN, YUEBO (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:YUEBO
Middle Name:
Last Name:GAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 E CHESTNUT AVENUE
Mailing Address - Street 2:7C
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5053
Mailing Address - Country:US
Mailing Address - Phone:215-762-7179
Mailing Address - Fax:
Practice Address - Street 1:1505 W SHERMAN AVENUE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7059
Practice Address - Country:US
Practice Address - Phone:856-690-1305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-01
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT 189556282N00000X
NJ25MA9045700207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No282N00000XHospitalsGeneral Acute Care Hospital