Provider Demographics
NPI:1790030682
Name:DOAN, JENNY PHUOC
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:PHUOC
Last Name:DOAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:THUAN
Other - Middle Name:PHUOC
Other - Last Name:DOAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2639 CAMINO DEL NINOS
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-8073
Mailing Address - Country:US
Mailing Address - Phone:714-623-1338
Mailing Address - Fax:
Practice Address - Street 1:2639 CAMINO DEL NINOS
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-8073
Practice Address - Country:US
Practice Address - Phone:714-623-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist