MEDICARE: DR. JASON EDWARD JENSEN M.D.

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	208600000X	Surgery Physician	04-45828	KS
2	208600000X	Surgery Physician	A188806	CA
3	208600000X	Surgery Physician	2022007515	MO

General Provider Information

NPI Number	:	1881128221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON EDWARD JENSEN M.D.

Provider Business Mailing Address
First Line	:	12291 WASHINGTON BLVD STE 102
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-3817
Country	:	US
Telephone Number	:	562-789-5444
Fax Number	:	562-789-4422

Provider Business Practice Location Address
First Line	:	12291 WASHINGTON BLVD STE 102
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90606-3817
Country	:	US
Telephone Number	:	562-789-5444
Fax Number	:	562-789-4422

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

Provider Enumeration Date	:	04/12/2017
Last Update Date	:	02/16/2024

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