Provider Demographics
NPI:1730570144
Name:DOAN STEPHENS, CRYSTAL THANH (MD)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:THANH
Last Name:DOAN STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:THANH
Other - Last Name:DOAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4305 UNIVERSITY AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1690
Mailing Address - Country:US
Mailing Address - Phone:619-280-2058
Mailing Address - Fax:858-633-4682
Practice Address - Street 1:4305 UNIVERSITY AVE STE 150
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1690
Practice Address - Country:US
Practice Address - Phone:619-280-2058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-07
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152267208000000X
CAD7884457390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program