Provider Demographics
NPI:1336382019
Name:MACEWAN, JENNIFER HUYEN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HUYEN
Last Name:MACEWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:HUYEN
Other - Last Name:TA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12630 MONTE VISTA RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2530
Mailing Address - Country:US
Mailing Address - Phone:858-674-1165
Mailing Address - Fax:
Practice Address - Street 1:12630 MONTE VISTA RD
Practice Address - Street 2:SUITE 206
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2530
Practice Address - Country:US
Practice Address - Phone:858-674-1165
Practice Address - Fax:858-312-1312
Is Sole Proprietor?:No
Enumeration Date:2009-04-11
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113181207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology