1356496772 NPI number — KAISER FOUNDATION HOSPITALS

Table of content: (NPI 1356496772)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356496772 NPI number — KAISER FOUNDATION HOSPITALS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAISER FOUNDATION HOSPITALS
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 FOUNDATION HOSPITAL - FONTANA
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:
1356496772
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9961 SIERRA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FONTANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92335-6720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-427-5000
Provider Business Mailing Address Fax Number:
909-427-7366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9961 SIERRA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FONTANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92335-6720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-427-5000
Provider Business Practice Location Address Fax Number:
909-427-7366
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
GEORGINA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
SVP AND AREA MANAGER
Authorized Official Telephone Number:
909-427-7701

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  240000159 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 050140B000000 . This is a "DHS - SECTION 1011" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 50140 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZA3603Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT40140F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 195323200 . This is a "USDOL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZT30140F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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