Provider Demographics
NPI:1760549026
Name:KAISER FOUNDATION HOSPITALS
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:KAISER FDN HSP INP PHY 14A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP NAT'L PHRMCY PROG & SVCS
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KVANCZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-658-3510
Mailing Address - Street 1:12254 BELLFLOWER BLVD
Mailing Address - Street 2:PHARMACY OPERATIONS
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27400 HESPERIAN BLVD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-4235
Practice Address - Country:US
Practice Address - Phone:510-784-4463
Practice Address - Fax:510-784-5219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X
CAHSP348703336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2111840OtherPK