Healthcare Provider Details

I. General information

NPI: 1962665216
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 EL CAMINO REAL
SOUTH SAN FRANCISCO CA
94080-3208
US

IV. Provider business mailing address

1034 MAGNOLIA ST
OAKLAND CA
94607-2231
US

V. Phone/Fax

Practice location:
  • Phone: 650-742-3199
  • Fax:
Mailing address:
  • Phone: 510-465-2350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number965781
License Number StateCA

VIII. Authorized Official

Name: DIANE VECCHI
Title or Position: REGISTERED DIETITIAN
Credential: MS, RD
Phone: 650-742-3199