Provider Demographics
NPI:1134922065
Name:VAYALIL, JENSEN JACOB
Entity type:Individual
Prefix:
First Name:JENSEN
Middle Name:JACOB
Last Name:VAYALIL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 WILLOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-3900
Mailing Address - Country:US
Mailing Address - Phone:630-280-5905
Mailing Address - Fax:
Practice Address - Street 1:351 WILLOWOOD LN
Practice Address - Street 2:
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-3900
Practice Address - Country:US
Practice Address - Phone:630-280-5905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program