Healthcare Provider Details

I. General information

NPI: 1275128910
Provider Name (Legal Business Name): SAMUEL IWAGUMA DUNHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG/SGXW 101 BODIN CIRCLE
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

60 MDG/SGXW 101 BODIN CIRCLE
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-5174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101275922
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: