1356520258 NPI number — DR. CHI MENG GAN M.D.

Table of content: DR. CHI MENG GAN M.D. (NPI 1356520258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356520258 NPI number — DR. CHI MENG GAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAN
Provider First Name:
CHI
Provider Middle Name:
MENG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356520258
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5127
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98206-5127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-453-1039
Provider Business Mailing Address Fax Number:
425-453-8955

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 112TH AVE NE STE C160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-453-1039
Provider Business Practice Location Address Fax Number:
425-453-8955
Provider Enumeration Date:
10/26/2007

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: 207Q00000X , with the licence number:  MD00042949 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G8800056 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0178441 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1119114 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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