Healthcare Provider Details

I. General information

NPI: 1073176830
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DUBLIN BLVD FL 2 RM 2615B
DUBLIN CA
94568-4363
US

IV. Provider business mailing address

1800 HARRISON STREET FL 13
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 925-556-5870
  • Fax:
Mailing address:
  • Phone: 510-625-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN RENOUARD BROWN
Title or Position: VP PHARMACY OPERATIONS & SVCS, NCAL
Credential:
Phone: 510-625-2363