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General NPI Number Information
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NPI Number | 1972606473
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Entity Type | Organization
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Legal Business Name | KAISER FOUNDATION HEALTH PLAN
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 3288 MOANALUA RD RADIOLOGY DEPARTMENT
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City | HONOLULU
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State | HI
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Zip | 96819-1469
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Country | US
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Telephone | 808-432-7341
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Fax | 808-432-7340
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Provider Business Mailing Address
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Address Line | 711 KAPIOLANI BLVD BILLING DEPARTMENT
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City | HONOLULU
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State | HI
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Zip | 96813-5214
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Country | US
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Telephone | 808-432-5312
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Fax | 808-432-5239
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | THOMAS J. RISSE
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Credential |
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Telephone | 808-432-5276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 150623
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License Number State | HI
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