Healthcare Provider Details

I. General information

NPI: 1629119359
Provider Name (Legal Business Name): KAISER FOUNDATION HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 S KIHEI RD STE 120
KIHEI HI
96753-5228
US

IV. Provider business mailing address

1279 S KIHEI RD STE 120
KIHEI HI
96753
US

V. Phone/Fax

Practice location:
  • Phone: 808-891-6860
  • Fax: 808-891-6861
Mailing address:
  • Phone: 808-891-6860
  • Fax: 808-891-6861

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-590
License Number StateHI

VIII. Authorized Official

Name: JEFFREY BERMEJO
Title or Position: PHARMACIST IN CHARGE
Credential:
Phone: 808-643-7979