Healthcare Provider Details

I. General information

NPI: 1265888630
Provider Name (Legal Business Name): KAISER FOUNDATION HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9521 DALEN ST RM R
DOWNEY CA
90242-4847
US

IV. Provider business mailing address

9521 DALEN ST RM R
DOWNEY CA
90242-4847
US

V. Phone/Fax

Practice location:
  • Phone: 562-401-4209
  • Fax:
Mailing address:
  • Phone: 562-401-4209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number993
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number41612
License Number StateCA

VIII. Authorized Official

Name: RHONDA LEE POLCHAK
Title or Position: VP PHARMACY OPERATIONS & SVCS, SCAL
Credential:
Phone: 562-658-3510