MEDICARE: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1821388521
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Provider Business Mailing Address
First Line	:	PO BOX 34584
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-1584
Country	:	US
Telephone Number	:	509-241-7349
Fax Number	:	509-241-7628

Provider Business Practice Location Address
First Line	:	1420 5TH AVE
Second Line	:	SUITE 375
City	:	SEATTLE
State	:	WA
Zip	:	98101-4087
Country	:	US
Telephone Number	:	206-223-2611
Fax Number	:	206-381-4671

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KATHY BEERY
Credential	:
Telephone Number	:	206-630-1818

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	06/22/2021

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