Provider Demographics
NPI:1366439051
Name:DO, JACLYNN J (MD)
Entity Type:Individual
Prefix:MISS
First Name:JACLYNN
Middle Name:J
Last Name:DO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10141 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4790
Mailing Address - Country:US
Mailing Address - Phone:714-467-4321
Mailing Address - Fax:714-467-4311
Practice Address - Street 1:10141 WESTMINSTER AVE
Practice Address - Street 2:SUITE E
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4788
Practice Address - Country:US
Practice Address - Phone:714-467-4321
Practice Address - Fax:714-467-4311
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA78520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A785200Medicaid
CA00A785200Medicaid