Provider Demographics
NPI:1447475413
Name:DO, JACQUELYN KHANH-PHUONG (DDS)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:KHANH-PHUONG
Last Name:DO
Suffix:
Gender:F
Credentials:DDS
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Mailing Address - Street 1:12835 POINTE DEL MAR WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3846
Mailing Address - Country:US
Mailing Address - Phone:858-755-0050
Mailing Address - Fax:858-755-0059
Practice Address - Street 1:12835 POINTE DEL MAR WAY STE 2
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3846
Practice Address - Country:US
Practice Address - Phone:858-755-0050
Practice Address - Fax:858-755-0059
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2019-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY50-0523651223P0221X
CA610811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry