Healthcare Provider Details

I. General information

NPI: 1295797322
Provider Name (Legal Business Name): SAMUEL KANG-NIEN DAWN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 AVENUE Q
LUBBOCK TX
79401-4732
US

IV. Provider business mailing address

1602 AVENUE Q
LUBBOCK TX
79401-4732
US

V. Phone/Fax

Practice location:
  • Phone: 650-766-0887
  • Fax: 650-249-5055
Mailing address:
  • Phone: 650-766-0887
  • Fax: 650-249-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA61175
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME172174
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberU7978
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA61175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: