Jacquelyn Khanh-Phuong DO, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

61081 Issued in CA

Practice address

12835 Pointe del Mar Way Ste 2
Del Mar, CA 92014-3846

Phone

(858) 755-0050

Fax

(858) 755-0059

NPI assigned

Apr 16, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553558400000",
    "number": "1447475413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12835 POINTE DEL MAR WAY STE 2",
            "city": "DEL MAR",
            "state": "CA",
            "postal_code": "920143846",
            "telephone_number": "858-755-0050",
            "fax_number": "858-755-0059"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12835 POINTE DEL MAR WAY STE 2",
            "city": "DEL MAR",
            "state": "CA",
            "postal_code": "920143846",
            "telephone_number": "858-755-0050",
            "fax_number": "858-755-0059"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "JACQUELYN",
        "middle_name": "KHANH-PHUONG",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-16",
        "last_updated": "2019-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "50-052365",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "61081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Jacob Del Rosario, ND
• Lanny M Deremer, PHARMD BCGP
• Dermatology & Laser of del Mar
• Dermatology and Laser of del Mar
• Michelle Detsch, PSY.D.
• Tiffany Kim DO, PHARMD
• Emily Ann Dodge, OTR/L
• Julie Doerre
• Dominguez Schalch Lepe Kaback Guarneri Medical Associates PC
• Deborah Donie-Seligson, LMFT

• Pediatric Dentistry in Del Mar, CA
• Providers in Del Mar, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.