Provider Demographics
NPI:1558320739
Name:JENSEN, STEEN W (MD FACS)
Entity Type:Individual
Prefix:DR
First Name:STEEN
Middle Name:W
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD FACS
Other - Prefix:
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Mailing Address - Street 1:1045 BUCKS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9507
Mailing Address - Country:US
Mailing Address - Phone:530-283-1506
Mailing Address - Fax:530-283-7149
Practice Address - Street 1:1065 BUCKS LAKE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9507
Practice Address - Country:US
Practice Address - Phone:530-283-1506
Practice Address - Fax:530-283-7953
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG75001208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G750010Medicaid
CA00G750010Medicare PIN
CA00G750010Medicaid