Provider Demographics
NPI:1548422108
Name:DO JACLYNN MD INC.
Entity Type:Organization
Organization Name:DO JACLYNN MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACLYNN
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-899-9898
Mailing Address - Street 1:8341 WESTMINSTER BLVD STE 101B
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-3306
Mailing Address - Country:US
Mailing Address - Phone:714-899-9898
Mailing Address - Fax:866-235-9464
Practice Address - Street 1:8341 WESTMINSTER BLVD STE 101B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3306
Practice Address - Country:US
Practice Address - Phone:714-899-9898
Practice Address - Fax:866-235-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty