=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538214556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAISER FOUNDATION HOSPITALS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 04/13/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4700 W SUNSET BLVD 2ND FLOOR
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-6082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-783-5706
-----------------------------------------------------
Fax | 323-783-6759
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4700 W SUNSET BLVD 2ND FLOOR
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90027-6082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-783-5706
-----------------------------------------------------
Fax | 323-783-6759
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | WILLIAM N GRICE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-783-8100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QE0700X
-----------------------------------------------------
Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
-----------------------------------------------------
License Number | 930000077
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------