MEDICARE: EAST BAY SHOULDER CLINIC AND SPORTS REHABILITATION, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1114027034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST BAY SHOULDER CLINIC AND SPORTS REHABILITATION, INC

Provider Business Mailing Address
First Line	:	PO BOX 1298
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-1298
Country	:	US
Telephone Number	:	925-284-5300
Fax Number	:	925-284-5381

Provider Business Practice Location Address
First Line	:	3717 MT DIABLO BLVD STE 100
Second Line	:
City	:	LAFAYETTE
State	:	CA
Zip	:	94549-3547
Country	:	US
Telephone Number	:	925-284-5300
Fax Number	:	925-284-5381

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KIRK L JENSEN
Credential	:	M.D.
Telephone Number	:	925-284-5300

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	03/21/2018

Similar Medicare Providers

1457398224 — KENNETH M CALDWELL MD
Practice Location Address:

3717 MT DIABLO BLVD STE 100
LAFAYETTE, CA
94549-3547

Practice Phone: 925-284-5300
Practice Fax: 925-284-5381

1063525244 — MICHAEL ALBERT OBERLANDER MD
Practice Location Address:

3717 MT DIABLO BLVD STE 100
LAFAYETTE, CA
94549-3547

Practice Phone: 925-284-5300
Practice Fax: 925-284-5381

1891809943 — KENNETH M. CALDWELL, MD, A MEDICAL CORPORATION
Practice Location Address:

3717 MT DIABLO BLVD STE 100
LAFAYETTE, CA
94549-3547

Practice Phone: 925-284-5300
Practice Fax: 925-284-5381

1881706810 — MRS. CARRIE SUSAN HARABURDA M.S.P.T.
Practice Location Address:

3717 MT. DIABLO BLVD , SUITE 100
LAFAYETTE, CA
94549-3547

Practice Phone: 925-284-5300
Practice Fax: 925-284-5381

1568553790 — KIRK L JENSEN MD
Practice Location Address:

3717 MT DIABLO BLVD STE 100
LAFAYETTE, CA
94549-3547

Practice Phone: 925-284-5300
Practice Fax: 925-354-5381

1689171233 — RACHEL FORER DDS
Practice Location Address:

3547 WILKINSON LN
LAFAYETTE, CA
94549-4322

Practice Phone: 925-962-5151
Practice Fax:

Directions to “EAST BAY SHOULDER CLINIC AND SPORTS REHABILITATION, INC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.