Provider Demographics
NPI:1720214059
Name:GAO, LAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LAN
Middle Name:
Last Name:GAO
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:253-681-6626
Mailing Address - Fax:503-626-9488
Practice Address - Street 1:4095 SW 144TH AVE STE A
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2368
Practice Address - Country:US
Practice Address - Phone:503-643-4719
Practice Address - Fax:503-626-9488
Is Sole Proprietor?:No
Enumeration Date:2009-06-01
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61395735122300000X, 1223G0001X
ORD7840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice