Provider Demographics
NPI:1235103680
Name:JENSEN, KEVIN VAL (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:VAL
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KEVIN
Other - Middle Name:VAL
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:321 N MALL DR STE J201
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7325
Mailing Address - Country:US
Mailing Address - Phone:435-986-9483
Mailing Address - Fax:435-215-4337
Practice Address - Street 1:321 N MALL DR STE J201
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7325
Practice Address - Country:US
Practice Address - Phone:435-986-9483
Practice Address - Fax:435-674-2997
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6380926-1205207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ131896Medicare PIN
NVE15057Medicare UPIN