Healthcare Provider Details

I. General information

NPI: 1629984067
Provider Name (Legal Business Name): SAMUEL DANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8579 SUMMIT RD
REYNOLDSBURG OH
43068-1411
US

IV. Provider business mailing address

1199 N BROADWAY ST APT 264
CARROLLTON TX
75006-0016
US

V. Phone/Fax

Practice location:
  • Phone: 614-501-2300
  • Fax:
Mailing address:
  • Phone: 330-232-2728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01934
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: