MEDICARE: GABRIELLE ERIN GAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT33973	CA

General Provider Information

NPI Number	:	1336626639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GABRIELLE ERIN GAN O.D.

Provider Business Mailing Address
First Line	:	PO BOX 9602
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91346-9602
Country	:	US
Telephone Number	:	818-837-5559
Fax Number	:	818-792-4793

Provider Business Practice Location Address
First Line	:	14550 W SOLEDAD CANYON ROAD
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91387-2200
Country	:	US
Telephone Number	:	661-250-5220
Fax Number	:	661-250-5285

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2018
Last Update Date	:	07/07/2023

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