Healthcare Provider Details

I. General information

NPI: 1689721904
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 I ST
MODESTO CA
95354-1121
US

IV. Provider business mailing address

1625 I ST
MODESTO CA
95354-1121
US

V. Phone/Fax

Practice location:
  • Phone: 209-557-1115
  • Fax: 209-557-1125
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberPHY41599
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: LYNN RILEY
Title or Position: OP PHARMACY MGR
Credential:
Phone: 209-557-1146