# EAST BAY SHOULDER CLINIC AND SPORTS REHABILITATION, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114027034
- **Authorized official:** DR. KIRK L JENSEN M.D. (PRESIDENT)
- **Authorized official phone:** (925) 284-5300

## Contact information

- **Practice address:** 3717 MT DIABLO BLVD STE 100, LAFAYETTE, CA 94549-3547
- **Practice address phone:** (925) 284-5300
- **Practice address fax:** (925) 284-5381
- **Mailing address:** PO BOX 1298, LAFAYETTE, CA 94549-1298
- **Mailing address phone:** (925) 284-5300
- **Mailing address fax:** (925) 284-5381

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/22/2006
- **Last updated:** 03/21/2018