MEDICARE: DR. YAN GAO MD

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	2085R0202X	Diagnostic Radiology Physician	MD208413	OR
2	2085R0202X	Diagnostic Radiology Physician	MD61498398	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00044367	OTHER	VA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65379	OTHER	VA	OPTIMA
2	65379	OTHER	VA	SENTARA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	139178	OTHER	VA	BCBS

General Provider Information

NPI Number	:	1881678985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YAN GAO MD

Provider Business Mailing Address
First Line	:	6040 NW MICHAELBROOK LN
Second Line	:
City	:	CAMAS
State	:	WA
Zip	:	98607-9152
Country	:	US
Telephone Number	:	757-642-2345
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 NE 87TH AVE
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98664-4896
Country	:	US
Telephone Number	:	360-397-3352
Fax Number	:

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

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	10/11/2024

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Directions to “ DR. YAN GAO MD” Practice Location

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