Healthcare Provider Details

I. General information

NPI: 1194882456
Provider Name (Legal Business Name): KAISER FOUNDATION HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 DALE RD FL 1
MODESTO CA
95356-9718
US

IV. Provider business mailing address

1800 HARRISON ST FL 13
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 209-557-1131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberHSP48272
License Number StateCA

VIII. Authorized Official

Name: KATHRYN RENOUARD BROWN
Title or Position: VP PHARMACY OPERATIONS AND SERVICES
Credential:
Phone: 510-625-2363