Provider Demographics
NPI:1962583815
Name:JENSEN, JORGEN (LAC)
Entity type:Individual
Prefix:
First Name:JORGEN
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:95 ARGONAUT
Mailing Address - Street 2:280
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4133
Mailing Address - Country:US
Mailing Address - Phone:949-598-9999
Mailing Address - Fax:949-598-9990
Practice Address - Street 1:1200 MT DIABLO BLVD
Practice Address - Street 2:202
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4852
Practice Address - Country:US
Practice Address - Phone:925-256-1133
Practice Address - Fax:925-256-0999
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAAC5477171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist