Provider Demographics
NPI:1275680506
Name:KAISER FOUNDATION HEALTH PLAN INC
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN INC
Other - Org Name:KAISER POINT WEST PEDIATRIC PHY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OP PHARMACY MGR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-614-4577
Mailing Address - Street 1:1650 RESPONSE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1650 RESPONSE RD FL 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4807
Practice Address - Country:US
Practice Address - Phone:916-614-4595
Practice Address - Fax:916-614-4580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY433193336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0576554OtherOTHER ID NUMBER
0576554OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CAPHA433190Medicaid