Healthcare Provider Details

I. General information

NPI: 1629729322
Provider Name (Legal Business Name): SAMANTHA JEUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 01/13/2022
Certification Date: 01/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 BARTLETT AVE
HAYWARD CA
94541-3698
US

IV. Provider business mailing address

5121 JAMES AVE
CASTRO VALLEY CA
94546-3745
US

V. Phone/Fax

Practice location:
  • Phone: 510-785-3630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number18635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: