Healthcare Provider Details

I. General information

NPI: 1003476359
Provider Name (Legal Business Name): SAMUEL DOONG DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 W OLYMPIC BLVD STE 101
LOS ANGELES CA
90064-1166
US

IV. Provider business mailing address

695 S VERMONT AVE APT 711
LOS ANGELES CA
90005-1979
US

V. Phone/Fax

Practice location:
  • Phone: 310-770-7586
  • Fax:
Mailing address:
  • Phone: 909-380-3463
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: