1992122659 NPI number — KAISER FOUNDATION HEALTH PLAN, INC.

Table of content: MRS. KIMBERLY SUE RIDILLA RPH (NPI 1215213715)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992122659 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:
Provider Other Organization Name Type Code:
6
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:
1992122659
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2024
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:
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96813-5237
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-432-5340
Provider Business Mailing Address Fax Number:
808-432-5349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98-1005 MOANALUA RD
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-432-5849
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2014

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: 291U00000X , with the licence number:  12D2060559 , 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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