Provider Demographics
NPI:1881678985
Name:GAO, YAN (MD)
Entity type:Individual
Prefix:DR
First Name:YAN
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6040 NW MICHAELBROOK LN
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-9152
Mailing Address - Country:US
Mailing Address - Phone:757-642-2345
Mailing Address - Fax:
Practice Address - Street 1:700 NE 87TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-4896
Practice Address - Country:US
Practice Address - Phone:360-397-3352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD2084132085R0202X
WAMD614983982085R0202X, 2085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA65379OtherOPTIMA
VA65379OtherSENTARA
NC89066HPMedicaid
VAP00044367OtherRR MEDICARE
VA7248628Medicaid
VA139178OtherBCBS
VA139178OtherBCBS
VA001772M13Medicare PIN