Provider Demographics
NPI:1275905101
Name:KAISER PERMANENTE
Entity Type:Organization
Organization Name:KAISER PERMANENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEMATOLOGY/ONCOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BAER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-752-6487
Mailing Address - Street 1:3131 ARCADIA CMN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94551-7552
Mailing Address - Country:US
Mailing Address - Phone:808-349-7160
Mailing Address - Fax:
Practice Address - Street 1:1800 HARRISON ST FL 13TH
Practice Address - Street 2:UNIT 1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3471
Practice Address - Country:US
Practice Address - Phone:510-695-1089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37557302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization