Basic Information
| Provider Information | |||||||||
| NPI: | 1497011563 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANG-CHENG | ||||||||
| FirstName: | SAMANTHA | ||||||||
| MiddleName: | PHOUA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12455 E 100TH ST N | ||||||||
| Address2: | STE 190 | ||||||||
| City: | OWASSO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740554675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184037054 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12455 E 100TH ST N STE 190 | ||||||||
| Address2: | |||||||||
| City: | OWASSO | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740554675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182745509 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2012 | ||||||||
| LastUpdateDate: | 07/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5642 | OK | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.