=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245577980
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAISER PERMANENTE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2013
-----------------------------------------------------
Last Update Date | 01/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 POPPY CT
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94596-5852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-816-2640
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 HARRISON ST
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94612-3466
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-625-2402
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL PHARMACY MANAGER
-----------------------------------------------------
Name | DR. FRANKLIN CHOY
-----------------------------------------------------
Credential | PHARM D
-----------------------------------------------------
Telephone | 510-625-2402
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | RPH31977
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------