Provider Demographics
NPI:1104087808
Name:GAN, TERENCE (MD MPH)
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:
Last Name:GAN
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3826 8TH AVE 260
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-4307
Mailing Address - Country:US
Mailing Address - Phone:858-626-7780
Mailing Address - Fax:
Practice Address - Street 1:808 4TH AVE APT 313
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6142
Practice Address - Country:US
Practice Address - Phone:626-485-8622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106013207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine