Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | M-8551 | ID |
NPI | 1407899594 |
---|---|
Provider Name | Dr. Kirk Ernest Jensen |
First Address | North Bethesda, MD 20852-2851 |
Second Address | Washington, DC 20307-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
M-8851 | STATE LISCENCE (01) | ID |