Provider Demographics
NPI:1235483199
Name:KAISER SUNNYSIDE MEDICAL CENTER
Entity Type:Organization
Organization Name:KAISER SUNNYSIDE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-571-4755
Mailing Address - Street 1:3480 MOCK ORANGE CT S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-3647
Mailing Address - Country:US
Mailing Address - Phone:503-314-6227
Mailing Address - Fax:
Practice Address - Street 1:3480 MOCK ORANGE CT S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-3647
Practice Address - Country:US
Practice Address - Phone:503-314-6227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR104100000XOtherSOCIAL WORK