Provider Demographics
NPI:1457304016
Name:HENDRICKSON, JAY A (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:A
Last Name:HENDRICKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 EAST BIDWELL ST
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3455
Mailing Address - Country:US
Mailing Address - Phone:916-984-3899
Mailing Address - Fax:916-984-6522
Practice Address - Street 1:729 SUNRISE AVE STE 602
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4542
Practice Address - Country:US
Practice Address - Phone:916-953-7571
Practice Address - Fax:916-771-8515
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83722208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG83722OtherLICENSE
CAG83722OtherLICENSE
CA00G837223Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER