Provider Demographics
NPI:1699564591
Name:SAMPANG, JANAL ANN
Entity type:Individual
Prefix:
First Name:JANAL
Middle Name:ANN
Last Name:SAMPANG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RAVILLA CT
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-1328
Mailing Address - Country:US
Mailing Address - Phone:415-518-8011
Mailing Address - Fax:
Practice Address - Street 1:190 W 25TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2272
Practice Address - Country:US
Practice Address - Phone:650-349-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor