Healthcare Provider Details

I. General information

NPI: 1225506199
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 WEST LN FL 1 RM #1310
STOCKTON CA
95210
US

IV. Provider business mailing address

1800 HARRISON ST FL 13
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 209-476-5478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN BROWN
Title or Position: VP PHARMACY OPERATIONS & SVCS, NCAL
Credential:
Phone: 510-625-2363