Healthcare Provider Details

I. General information

NPI: 1669542510
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7375 WEST LANE
STOCKTON CA
95210
US

IV. Provider business mailing address

5614 SAINT ANDREWS DR
STOCKTON CA
95219-1928
US

V. Phone/Fax

Practice location:
  • Phone: 209-476-2080
  • Fax:
Mailing address:
  • Phone: 209-951-0888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. MARLEEN ANNE YU-LI
Title or Position: PHYSICIAN
Credential: MD
Phone: 209-476-3422