MEDICARE: SAMANTHA ISIUWA OKUNDIA DO

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	208D00000X	General Practice Physician	W5910	TX
2	208600000X	Surgery Physician	W5910	TX

General Provider Information

NPI Number	:	1962195297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ISIUWA OKUNDIA DO

Provider Business Mailing Address
First Line	:	3746 FOOTHILL BLVD # B140
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91214-1740
Country	:	US
Telephone Number	:	310-445-5999
Fax Number	:	323-544-4248

Provider Business Practice Location Address
First Line	:	2101 CEDAR SPRINGS RD STE 1050
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75201-2165
Country	:	US
Telephone Number	:	310-445-5999
Fax Number	:	323-544-4248

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

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	06/10/2026

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