MEDICARE: KAISER PERMENANTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization	A76751	CA

General Provider Information

NPI Number	:	1942463419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAISER PERMENANTE

Provider Business Mailing Address
First Line	:	2431 BUCKINGHAM LN
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90077-1335
Country	:	US
Telephone Number	:	310-658-0878
Fax Number	:

Provider Business Practice Location Address
First Line	:	6041 CADILLAC AVE
Second Line	:	FAMILY MEDICINE/AAH
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-1335
Country	:	US
Telephone Number	:	800-954-8000
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. HOWARD S YEH
Credential	:	MD
Telephone Number	:	310-658-0878

Provider Enumeration Date	:	07/05/2008
Last Update Date	:	07/08/2008

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Directions to “KAISER PERMENANTE ” Practice Location

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