Provider Demographics
NPI:1669487047
Name:KAISER FOUNDATION HEALTH PLAN INC
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN INC
Other - Org Name:KAISER WAILUKU CLINIC LABORATORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, FINANACE LEADER
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:BILLING DEPARTMENT
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5214
Mailing Address - Country:US
Mailing Address - Phone:808-432-5340
Mailing Address - Fax:808-432-5239
Practice Address - Street 1:80 MAHALANI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2531
Practice Address - Country:US
Practice Address - Phone:808-243-6180
Practice Address - Fax:808-243-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12D0064381291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI549983-01Medicaid
HIH52387Medicare PIN