Provider Demographics
NPI:1881128221
Name:JENSEN, JASON EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:EDWARD
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12291 WASHINGTON BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-3817
Mailing Address - Country:US
Mailing Address - Phone:562-789-5444
Mailing Address - Fax:562-789-4422
Practice Address - Street 1:12291 WASHINGTON BLVD STE 102
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-3817
Practice Address - Country:US
Practice Address - Phone:562-789-5444
Practice Address - Fax:562-789-4422
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-45828208600000X
CAA188806208600000X
MO2022007515208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery