Healthcare Provider Details

I. General information

NPI: 1194820472
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 02/01/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1480 MOANIANI ST RADIOLOGY DEPARTMENT
WAIPAHU HI
96797-4632
US

IV. Provider business mailing address

711 KAPIOLANI BLVD BILLING DEPARTMENT
HONOLULU HI
96813-5214
US

V. Phone/Fax

Practice location:
  • Phone: 808-432-3190
  • Fax: 808-432-3183
Mailing address:
  • Phone: 808-432-5340
  • Fax: 808-432-5239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number203802
License Number StateHI

VIII. Authorized Official

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