Provider Demographics
NPI:1922645829
Name:PHILIP, JENSEN (ARDMS, RVT)
Entity Type:Individual
Prefix:MR
First Name:JENSEN
Middle Name:
Last Name:PHILIP
Suffix:
Gender:M
Credentials:ARDMS, RVT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 WINDBLOWN LN
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-8424
Mailing Address - Country:US
Mailing Address - Phone:650-995-2444
Mailing Address - Fax:
Practice Address - Street 1:11 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-6530
Practice Address - Country:US
Practice Address - Phone:650-995-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty