Healthcare Provider Details

I. General information

NPI: 1376688093
Provider Name (Legal Business Name): JANE JUI-CHIN GAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 NORTH MAIN LA CASA NUEVA DE AMIGOS
HOUSTON TX
77009
US

IV. Provider business mailing address

P O BOX 88361 CITY OF HOUSTON HEALTH & HUMAN SERVICES
HOUSTON TX
77288-8861
US

V. Phone/Fax

Practice location:
  • Phone: 713-547-8076
  • Fax: 713-547-8130
Mailing address:
  • Phone: 713-794-9104
  • Fax: 713-798-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number21178
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: