Healthcare Provider Details

I. General information

NPI: 1821164476
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MAHALANI ST
WAILUKU HI
96793-2531
US

IV. Provider business mailing address

711 KAPIOLANI BLVD BILLING DEPARTMENT
HONOLULU HI
96813-5214
US

V. Phone/Fax

Practice location:
  • Phone: 808-243-6000
  • Fax: 808-243-6627
Mailing address:
  • Phone: 808-432-5312
  • Fax: 808-432-5239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberHMF FSOF-10
License Number StateHI

VIII. Authorized Official

Name: JAMES G. ADAM JR.
Title or Position: EXECUTIVE DIRECTOR, FINANCE LEADER
Credential:
Phone: 808-286-6758