Healthcare Provider Details

I. General information

NPI: 1932511573
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 2ND ST STE B
BERKELEY CA
94710-1704
US

IV. Provider business mailing address

1800 HARRISON ST FL 13
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 510-559-5400
  • Fax:
Mailing address:
  • Phone: 510-559-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHY51900
License Number StateCA

VIII. Authorized Official

Name: KATHRYN RENOUARD BROWN
Title or Position: VP PHARMACY OPERATIONS AND SERVICES
Credential:
Phone: 510-625-2363