Provider Demographics
NPI:1356366876
Name:DINH, JACK (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:DINH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40404 CALIFORNIA OAKS RD
Mailing Address - Street 2:STE C
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5786
Mailing Address - Country:US
Mailing Address - Phone:609-519-1105
Mailing Address - Fax:
Practice Address - Street 1:40404 CALIFORNIA OAKS RD
Practice Address - Street 2:SUITE C
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5786
Practice Address - Country:US
Practice Address - Phone:609-519-1105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97273207RG0100X
NJ25MA07782100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology