1881068377 NPI number — KAISER FOUNDATION HEALTH PLAN INC

Table of content: (NPI 1881068377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881068377 NPI number — KAISER FOUNDATION HEALTH PLAN INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAISER FOUNDATION HEALTH PLAN INC
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 LIHUE PHARMACY
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:
1881068377
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:
4366 KUKUI GROVE ST STE 101
Provider Second Line Business Mailing Address:
KAISER LIHUE PHARMACY
Provider Business Mailing Address City Name:
LIHUE
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96766-2006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-246-5624
Provider Business Mailing Address Fax Number:
808-246-5620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4366 KUKUI GROVE ST STE 101
Provider Second Line Business Practice Location Address:
KAISER LIHUE PHARMACY
Provider Business Practice Location Address City Name:
LIHUE
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96766-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-246-5624
Provider Business Practice Location Address Fax Number:
808-246-5620
Provider Enumeration Date:
11/20/2015

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:
808-286-6758

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: PHY-897 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336M0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2155444 . This is a "PK" identifier . This identifiers is of the category "OTHER".