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1235103680 NPI number — KEVIN VAL JENSEN M.D.

NPI Number: 1235103680
Health Care Provider/Practitioner: KEVIN VAL JENSEN M.D.

Information about “1235103680” NPI (KEVIN VAL JENSEN M.D.) exists in 1235103680 in HTML format HTML  |  1235103680 in plain Text format TXT  |  1235103680 in PDF (Portable Document Format) PDF  |  1235103680 in an XML format XML  formats.

NPI Number : 1235103680 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1235103680",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JENSEN",
    "FirstName": "KEVIN",
    "MiddleName": "VAL",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JENSEN",
    "OtherFirstName": "KEVIN",
    "OtherMiddleName": "VAL",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "321 N MALL DR STE J201",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT GEORGE",
    "MailingAddressStateName": "UT",
    "MailingAddressPostalCode": "84790-7325",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "435-986-9483",
    "MailingAddressFaxNumber": "435-215-4337",
    "FirstLinePracticeLocationAddress": "321 N MALL DR STE J201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ST GEORGE",
    "PracticeLocationAddressStateName": "UT",
    "PracticeLocationAddressPostalCode": "84790-7325",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "435-986-9483",
    "PracticeLocationAddressFaxNumber": "435-674-2997",
    "EnumerationDate": "02/14/2006",
    "LastUpdateDate": "12/04/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207P00000X",
        "TaxonomyName": "Emergency Medicine Physician",
        "LicenseNumber": "6380926-1205",
        "LicenseNumberStateCode": "UT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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