Healthcare Provider Details

I. General information

NPI: 1447057526
Provider Name (Legal Business Name): AJ PHYSICIAN ASSISTANT PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2025
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 THE STRAND AVE
SAN JOSE CA
95120-3857
US

IV. Provider business mailing address

1617 THE STRAND AVE
SAN JOSE CA
95120-3857
US

V. Phone/Fax

Practice location:
  • Phone: 408-627-1126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: AMANDA JENSEN
Title or Position: OWNER/EMPLOYEE
Credential: PA-C
Phone: 408-627-1126