Provider Demographics
NPI:1104889617
Name:MCCLENDON, JAKLYN RAE (MD)
Entity type:Individual
Prefix:DR
First Name:JAKLYN
Middle Name:RAE
Last Name:MCCLENDON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1111 W LA PALMA AVE
Mailing Address - Street 2:DEPT. OF PATHOLOGY
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2804
Mailing Address - Country:US
Mailing Address - Phone:714-999-6075
Mailing Address - Fax:714-999-3822
Practice Address - Street 1:1111 W LA PALMA AVE
Practice Address - Street 2:AMMC - DEPT. OF PATHOLOGY
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2804
Practice Address - Country:US
Practice Address - Phone:714-999-6075
Practice Address - Fax:714-999-3822
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG50440207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G504400Medicaid
CAF28901Medicare UPIN
CA00G504400Medicaid