Healthcare Provider Details

I. General information

NPI: 1407899594
Provider Name (Legal Business Name): KIRK ERNEST JENSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED ARMY MEDICAL CENTER 6900 GEORGIA AVE
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

5828 TUDOR LN
NORTH BETHESDA MD
20852-2851
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6101
  • Fax: 202-782-0774
Mailing address:
  • Phone: 240-669-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberM-8551
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: