Healthcare Provider Details

I. General information

NPI: 1396621538
Provider Name (Legal Business Name): SAMANTHA WOO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2025
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 SAWTELLE BLVD
LOS ANGELES CA
90025-7006
US

IV. Provider business mailing address

1598 MARLESTA RD
PINOLE CA
94564-2449
US

V. Phone/Fax

Practice location:
  • Phone: 510-689-3274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number94413153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: