Healthcare Provider Details

I. General information

NPI: 1750402228
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MAUI LANI PKWY
WAILUKU HI
96793-2416
US

IV. Provider business mailing address

55 MAUI LANI PKWY
WAILUKU HI
96793-2416
US

V. Phone/Fax

Practice location:
  • Phone: 808-243-6565
  • Fax: 808-243-6568
Mailing address:
  • Phone: 808-243-6565
  • Fax: 808-243-6568

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-654
License Number StateHI

VIII. Authorized Official

Name: DANE LUNA
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM D
Phone: 808-243-6565