Provider Demographics
NPI:1568553790
Name:JENSEN, KIRK L (MD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:L
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1298
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-1298
Mailing Address - Country:US
Mailing Address - Phone:925-284-5300
Mailing Address - Fax:925-284-5381
Practice Address - Street 1:3717 MT DIABLO BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3547
Practice Address - Country:US
Practice Address - Phone:925-284-5300
Practice Address - Fax:925-354-5381
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG68904207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG68904OtherMEDICAL LICENSE NUMBER