Provider Demographics
NPI:1982855417
Name:NGUYEN, JACQUELYN YEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:YEN
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 S SEPULVEDA BLVD APT 159
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-3941
Mailing Address - Country:US
Mailing Address - Phone:714-307-5029
Mailing Address - Fax:
Practice Address - Street 1:2901 S SEPULVEDA BLVD APT 159
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-3941
Practice Address - Country:US
Practice Address - Phone:714-307-5029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102714207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine