Healthcare Provider Details

I. General information

NPI: 1073661815
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E HACIENDA AVE
CAMPBELL CA
95008-6617
US

IV. Provider business mailing address

12254 BELLFLOWER BLVD FL 2 PHARMACY PROFESSIONAL AFFAIRS
DOWNEY CA
90242-2804
US

V. Phone/Fax

Practice location:
  • Phone: 408-871-5860
  • Fax: 408-871-5865
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY46383
License Number StateCA

VIII. Authorized Official

Name: DAVID KVANCZ
Title or Position: VP NAT'L PHARMACY PROG & SVCS
Credential:
Phone: 562-658-3510