Healthcare Provider Details

I. General information

NPI: 1780639724
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 PA A ST STE 2400
HONOLULU HI
96819
US

IV. Provider business mailing address

2828 PA A ST STE 2400
HONOLULU HI
96819
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-5760
  • Fax: 808-432-5759
Mailing address:
  • Phone: 808-432-5760
  • Fax: 808-432-5759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License NumberPHY-671
License Number StateHI

VIII. Authorized Official

Name: SUTHANA TEPRASEUTH
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 808-432-5702