Provider Demographics
NPI:1376698043
Name:KAISER FOUNDATION HOSPITALS
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:KAISER FOUNDATION HOSPITAL PANORAMA CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-375-2131
Mailing Address - Street 1:13652 CANTARA ST
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-5423
Mailing Address - Country:US
Mailing Address - Phone:818-375-2131
Mailing Address - Fax:
Practice Address - Street 1:13652 CANTARA ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-375-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000080282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZT40137FMedicaid
CAZZT30137FMedicaid
CA050137B000000OtherDHS SECTION 1011
CA339040906OtherUSDOL
CAZZZA1940ZOtherBLUE SHIELD
CA50137OtherBLUE CROSS
CAZZT30137FMedicaid
CAW176Medicare ID - Type UnspecifiedNHIC
CAZZT40137FMedicaid