Provider Demographics
NPI:1891813739
Name:JENSEN, KATHLEEN KAREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:KAREN
Last Name:JENSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 CULVER BLVD
Mailing Address - Street 2:GARDEN SUITE B
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3175
Mailing Address - Country:US
Mailing Address - Phone:424-298-0580
Mailing Address - Fax:310-838-6497
Practice Address - Street 1:10100 CULVER BLVD
Practice Address - Street 2:GARDEN SUITE B
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3175
Practice Address - Country:US
Practice Address - Phone:424-298-0580
Practice Address - Fax:310-838-6497
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA226211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice