Individual
GARY L JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
255 E BONITA AVE, POMONA, CA 91767-1923
(909) 450-0393
(909) 450-0394
Mailing address
PO BOX 480033, LOS ANGELES, CA 90048-1033
(909) 450-0393
(909) 450-0394
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
A43613
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A436130
BLUE SHIELD OF CA
CA
05
—
00A436130
—
CA
Enumeration date
06/13/2006
Last updated
07/08/2007
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