Provider Demographics
NPI:1548334527
Name:JENSEN, JAY ARTHUR (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:ARTHUR
Last Name:JENSEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 790W
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-829-7824
Mailing Address - Fax:310-453-6541
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 790W
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-829-7824
Practice Address - Fax:310-453-6541
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG046893208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG046893OtherLICENSE NUMBER
E48106Medicare UPIN