MEDICARE: DR. TAMARA STEIN JENSEN MD

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	208000000X	Pediatrics Physician	7352414-1205	UT
2	208D00000X	General Practice Physician	7352414-1205	UT

General Provider Information

NPI Number	:	1669631826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMARA STEIN JENSEN MD

Provider Business Mailing Address
First Line	:	295 CHIPETA WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84108-1287
Country	:	US
Telephone Number	:	801-587-7450
Fax Number	:	801-587-7455

Provider Business Practice Location Address
First Line	:	4141 S HIGHLAND DR STE 204
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84124-2642
Country	:	US
Telephone Number	:	801-998-8701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	01/16/2025

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