Provider Demographics
NPI:1760141519
Name:KAISER PERMANENTE
Entity Type:Organization
Organization Name:KAISER PERMANENTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ARIA
Authorized Official - Middle Name:AYSHA
Authorized Official - Last Name:KADDOURA
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:925-808-8808
Mailing Address - Street 1:2212 OAK HILLS CIR APT 24
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4221
Mailing Address - Country:US
Mailing Address - Phone:925-808-8808
Mailing Address - Fax:
Practice Address - Street 1:2212 OAK HILLS CIR APT 24
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4221
Practice Address - Country:US
Practice Address - Phone:925-808-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-09
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty