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General NPI Number Information
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NPI Number | 1518223429
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Entity Type | Organization
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Legal Business Name | KAISER PERMANENTE
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 04/04/2012
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Provider Practice Location Address
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Address Line | 1200 EL CAMINO REAL 3RD FLOOR PSYCHIATRY
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-3208
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Country | US
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Telephone | 650-742-3955
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Fax | 650-742-2591
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Provider Business Mailing Address
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Address Line | 1200 EL CAMINO REAL 3RD FLOOR PSYCHIATRY
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City | SOUTH SAN FRANCISCO
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State | CA
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Zip | 94080-3208
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Country | US
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Telephone | 650-742-3955
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Fax | 650-742-2591
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Authorized Official
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Title or Position | CHIEF OF PSYCHIATRY
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Name | MR. ALAN MARX
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Credential | MD
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Telephone | 650-742-2478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | LCS 28016
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License Number State | CA
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