Healthcare Provider Details

I. General information

NPI: 1780829408
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 NAPLES ST
SAN FRANCISCO CA
94112-2824
US

IV. Provider business mailing address

550 NAPLES ST
SAN FRANCISCO CA
94112-2824
US

V. Phone/Fax

Practice location:
  • Phone: 650-438-1184
  • Fax:
Mailing address:
  • Phone: 650-438-1184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number370237
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number370237
License Number StateCA

VIII. Authorized Official

Name: MERCEDES LOPEZ
Title or Position: RAD TECH
Credential: ARRT
Phone: 650-438-1184