Provider Demographics
NPI:1356799175
Name:JENSEN, KENDAL (MD PHD)
Entity type:Individual
Prefix:DR
First Name:KENDAL
Middle Name:
Last Name:JENSEN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:FILE 1440
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91199-1440
Mailing Address - Country:US
Mailing Address - Phone:858-939-3660
Mailing Address - Fax:858-939-3647
Practice Address - Street 1:9295 FARNHAM ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1254
Practice Address - Country:US
Practice Address - Phone:858-939-3660
Practice Address - Fax:858-939-3647
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA168743207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty