Provider Demographics
NPI:1093881641
Name:KAISER FOUNDATION HEALTH PLAN
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN
Other - Org Name:KAISER PERMANENTE MAPUNAPUNA CLINIC AMBULATORY SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, FINANCE LEADER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:808-286-6758
Mailing Address - Street 1:711 KAPIOLANI BLVD
Mailing Address - Street 2:BILLING DEPARTMENT
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5214
Mailing Address - Country:US
Mailing Address - Phone:808-432-5312
Mailing Address - Fax:808-432-5239
Practice Address - Street 1:2828 PAA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4430
Practice Address - Country:US
Practice Address - Phone:808-432-5738
Practice Address - Fax:808-432-5730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIFSOF-8261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI588783Medicaid
HI588783Medicaid