Provider Demographics
NPI:1245773936
Name:KAISER FOUNDATION HEALTH PLAN, INC
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN, INC
Other - Org Name:
Other - Org Type:
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:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5237
Mailing Address - Country:US
Mailing Address - Phone:808-432-5340
Mailing Address - Fax:808-432-5239
Practice Address - Street 1:56-565 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:KAHUKU
Practice Address - State:HI
Practice Address - Zip Code:96731-2202
Practice Address - Country:US
Practice Address - Phone:808-432-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAISER FOUNDATION HEALTH PLAN, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-29
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH52387Medicare PIN