Healthcare Provider Details

I. General information

NPI: 1801531272
Provider Name (Legal Business Name): RICHARD CLYDE JENSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST STE 3400
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V ST STE 3400
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-4597
  • Fax: 916-734-7924
Mailing address:
  • Phone: 916-734-4597
  • Fax: 916-734-7924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number201054
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberA201054
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: