Healthcare Provider Details

I. General information

NPI: 1417887068
Provider Name (Legal Business Name): SAMANTHA JANG OD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 W UTOPIA RD
GLENDALE AZ
85308-5251
US

IV. Provider business mailing address

1841 REDONDO RD
WEST SACRAMENTO CA
95691-4937
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: