Healthcare Provider Details

I. General information

NPI: 1902069172
Provider Name (Legal Business Name): KJ MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 FILER AVE
TWIN FALLS ID
83301-4008
US

IV. Provider business mailing address

615 FILER AVE
TWIN FALLS ID
83301-4008
US

V. Phone/Fax

Practice location:
  • Phone: 208-733-9242
  • Fax: 208-733-2810
Mailing address:
  • Phone: 208-733-9242
  • Fax: 208-733-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1260CP
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number1260CP
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number1260CP
License Number StateID

VIII. Authorized Official

Name: MR. KENT JENSEN
Title or Position: PHARMACIST
Credential: RPH
Phone: 208-733-9242