Provider Demographics
NPI:1902951130
Name:KRAIG JENSON PC
Entity Type:Organization
Organization Name:KRAIG JENSON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KRAIG
Authorized Official - Middle Name:KRUEGER
Authorized Official - Last Name:JENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAD
Authorized Official - Phone:801-224-5200
Mailing Address - Street 1:1385 E 750 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-5480
Mailing Address - Country:US
Mailing Address - Phone:801-224-5200
Mailing Address - Fax:801-224-2667
Practice Address - Street 1:1385 E 750 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-5480
Practice Address - Country:US
Practice Address - Phone:801-224-5200
Practice Address - Fax:801-224-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT164938-1205174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty