Provider Demographics
NPI:1689646952
Name:DO, JACQUELINE THANHHUYEN (MD)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:THANHHUYEN
Last Name:DO
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 1:1095 IRVINE BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3526
Mailing Address - Country:US
Mailing Address - Phone:714-505-7110
Mailing Address - Fax:714-505-7108
Practice Address - Street 1:1095 IRVINE BLVD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3526
Practice Address - Country:US
Practice Address - Phone:714-505-7110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78274207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT3338541OtherDEA
CAG01046Medicare UPIN