Provider Demographics
NPI:1811700511
Name:JENSEN, AYDIN MERIBA
Entity type:Individual
Prefix:MRS
First Name:AYDIN
Middle Name:MERIBA
Last Name:JENSEN
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 1:295 S CHIPETA WAY STE 22
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108-1234
Mailing Address - Country:US
Mailing Address - Phone:435-496-1048
Mailing Address - Fax:
Practice Address - Street 1:295 S CHIPETA WAY STE 22
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108-1234
Practice Address - Country:US
Practice Address - Phone:435-496-1048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program