Provider Demographics
NPI:1336294040
Name:KAISER FOUNDATION HOSPITALS
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:KAISER FOUNDATION HOSPITAL - SOUTH BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-517-2745
Mailing Address - Street 1:25825 SOUTH VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3518
Mailing Address - Country:US
Mailing Address - Phone:310-325-5111
Mailing Address - Fax:
Practice Address - Street 1:25825 SOUTH VERMONT AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3518
Practice Address - Country:US
Practice Address - Phone:310-325-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000079282N00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA339040905OtherUSDOL
CAZZZC1971ZOtherBLUE SHIELD
CA50411OtherBLUE CROSS
CAZZT40411FMedicaid
CA050411B000000OtherDHS SECTION 1011
CAZZT30411FMedicaid
CA=========90710-0000OtherTRICARE
CAZZZC1971ZOtherBLUE SHIELD
CA50411OtherBLUE CROSS