1700980364 NPI number — KAISER FOUNDATION HEALTH PLAN

Table of content: (NPI 1700980364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700980364 NPI number — KAISER FOUNDATION HEALTH PLAN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAISER FOUNDATION HEALTH PLAN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KAISER WAILUKU CLINIC RADIOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700980364
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
711 KAPIOLANI BLVD
Provider Second Line Business Mailing Address:
BILLING DEPARTMENT
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-5214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-432-5312
Provider Business Mailing Address Fax Number:
808-432-5239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 MAHALANI ST
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
WAILUKU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96793-2531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-243-6517
Provider Business Practice Location Address Fax Number:
808-243-6634
Provider Enumeration Date:
09/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR, FINANCE LEADER
Authorized Official Telephone Number:
808-286-6765

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  174516 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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