Healthcare Provider Details

I. General information

NPI: 1669631826
Provider Name (Legal Business Name): TAMARA STEIN JENSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMARA STEIN MD

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 S HIGHLAND DR STE 204
HOLLADAY UT
84124-2642
US

IV. Provider business mailing address

295 CHIPETA WAY
SALT LAKE CITY UT
84108-1287
US

V. Phone/Fax

Practice location:
  • Phone: 801-998-8701
  • Fax:
Mailing address:
  • Phone: 801-587-7450
  • Fax: 801-587-7455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7352414-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number7352414-1205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: