Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 2018014354 | MO |
Y | 213EG0000X | General Practice | 2018014354 | MO |
NPI | 1003306390 |
---|---|
Provider Name | Dr. Cory Jenson |
First Address | Kansas City, MO 64119-2502 |
Second Address | Kansas City, MO 64119-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2018 |
Last Update Date | 13/05/2018 |