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General NPI Number Information
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NPI Number | 1366439051
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Entity Type | Individual
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Provider Name | JACLYNN J DO M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10141 WESTMINSTER AVE SUITE E
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City | GARDEN GROVE
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State | CA
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Zip | 92843-4788
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Country | US
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Telephone | 714-467-4321
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Fax | 714-467-4311
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Provider Business Mailing Address
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Address Line | 10141 WESTMINSTER AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92843-4790
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Country | US
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Telephone | 714-467-4321
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Fax | 714-467-4311
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A78520
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License Number State | CA
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