Healthcare Provider Details

I. General information

NPI: 1265400097
Provider Name (Legal Business Name): SAMUEL TSANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 555191
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

270 N EL CAMINO REAL # F393
ENCINITAS CA
92024-2874
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-4856
  • Fax:
Mailing address:
  • Phone: 858-366-8777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG77859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: