1235014143 NPI number — DR. KIRSTEN LEI JENSEN PPS CRED 150094777

Table of content: DR. KIRSTEN LEI JENSEN PPS CRED 150094777 (NPI 1235014143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235014143 NPI number — DR. KIRSTEN LEI JENSEN PPS CRED 150094777

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JENSEN
Provider First Name:
KIRSTEN
Provider Middle Name:
LEI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PPS CRED 150094777
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JENSEN-SANDBLOOM
Provider Other First Name:
KIRSTEN
Provider Other Middle Name:
LEI
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PPS SCHOOL COUNSELIN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235014143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10293 BLOOMFIELD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ALAMITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90720-2264
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-799-4740
Provider Business Mailing Address Fax Number:
562-799-4773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10821 OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ALAMITOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90720-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-799-4740
Provider Business Practice Location Address Fax Number:
562-799-4773
Provider Enumeration Date:
08/08/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YS0200X , with the licence number:  1500094777 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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