Provider Demographics
NPI:1477662153
Name:KAISER PERMANENTE NW REGION
Entity Type:Organization
Organization Name:KAISER PERMANENTE NW REGION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF OB/GYN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-891-6231
Mailing Address - Street 1:5105 SE TIBBETTS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2166
Mailing Address - Country:US
Mailing Address - Phone:971-221-9466
Mailing Address - Fax:
Practice Address - Street 1:KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST, MT, TAL
Practice Address - Street 2:10100 SE SUNNYSIDE ROAD
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9764
Practice Address - Country:US
Practice Address - Phone:503-571-3711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200540324RN302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization