Active NPI
Yu Gan, D.M.D.
- General Practice Dentistry
- League City, TX
National Provider Identifier
1992099238
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 30791
- Practice address
- 4611 Miramar Dr
League City, TX 77573-1452 - Phone
- (702) 460-7656
- NPI assigned
- Jun 3, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 30791 | TX | Primary |
Addresses
Primary practice location
4611 Miramar Dr
League City, TX 77573-1452
Mailing address
2325 Echo Harbor Dr
Pearland, TX 77584-1570
Phone (702) 460-7656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30791 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591833600000",
"number": "1992099238",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2325 ECHO HARBOR DR",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775841570",
"telephone_number": "702-460-7656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4611 MIRAMAR DR",
"city": "LEAGUE CITY",
"state": "TX",
"postal_code": "775731452",
"telephone_number": "702-460-7656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAN",
"first_name": "YU",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-03",
"last_updated": "2020-06-11",
"certification_date": "2020-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "30791",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in League City, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.