Healthcare Provider Details

I. General information

NPI: 1821918541
Provider Name (Legal Business Name): LING GAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 E MOUNTAIN ST
WORCESTER MA
01606-1207
US

IV. Provider business mailing address

2550 N HOLLYWOOD WAY
BURBANK CA
91505-1055
US

V. Phone/Fax

Practice location:
  • Phone: 508-263-9980
  • Fax:
Mailing address:
  • Phone: 978-203-4773
  • Fax: 978-203-4773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: