Provider Demographics
NPI:1255569596
Name:GU, YAN (MD)
Entity type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:GU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:800-321-9999
Mailing Address - Fax:267-339-3761
Practice Address - Street 1:510 TOWNSHIP LINE RD STE 110
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-2721
Practice Address - Country:US
Practice Address - Phone:267-339-3558
Practice Address - Fax:267-339-3763
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09494900208100000X
PAMD446949208100000X, 208100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation