1629293501 NPI number — DR. YAN ZHOU GARDNER DDS

Table of content: DR. YAN ZHOU GARDNER DDS (NPI 1629293501)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629293501 NPI number — DR. YAN ZHOU GARDNER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARDNER
Provider First Name:
YAN
Provider Middle Name:
ZHOU
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GARDNER
Provider Other First Name:
YAN
Provider Other Middle Name:
ZHOU
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629293501
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8642 MAIN STREET
Provider Second Line Business Mailing Address:
#220
Provider Business Mailing Address City Name:
WILSONVILLE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-582-8255
Provider Business Mailing Address Fax Number:
503-582-9355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8642 MAIN STREET
Provider Second Line Business Practice Location Address:
#220
Provider Business Practice Location Address City Name:
WILSONVILLE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-582-8255
Provider Business Practice Location Address Fax Number:
503-582-9355
Provider Enumeration Date:
04/16/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  D7429 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)