Healthcare Provider Details

I. General information

NPI: 1154479905
Provider Name (Legal Business Name): KAISER FOUNDATION HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27400 HESPERIAN BLVD
HAYWARD CA
94545-4235
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: 510-784-6716
  • Fax: 510-784-6717
Mailing address:
  • Phone: 562-658-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY46815
License Number StateCA

VIII. Authorized Official

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