Provider Demographics
NPI:1326282393
Name:KAISER FOUNDATION HEALTH PLAN, INC
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN, INC
Other - Org Name:KAISER HAWAII MOBILE HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:ED, FINANCE LEADER HAWAII
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 1:67-1185 MAMALAHOA HWY UNIT A
Practice Address - Street 2:WAIMEA CLINIC
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8412
Practice Address - Country:US
Practice Address - Phone:808-881-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH52387Medicare PIN