Healthcare Provider Details

I. General information

NPI: 1407212277
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

9444 HARBOUR POINT DR APT 254
ELK GROVE CA
95758-3714
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-4840
  • Fax:
Mailing address:
  • Phone: 626-758-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number69743
License Number StateCA

VIII. Authorized Official

Name: DR. SUNGHUI CRUZ
Title or Position: PHARMACY SUPERVISOR
Credential: PHARMD
Phone: 916-973-4840