Provider Demographics
NPI:1780639724
Name:KAISER FOUNDATION HEALTH PLAN INC
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:SUTHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEPRASEUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-432-5702
Mailing Address - Street 1:2828 PA A ST
Mailing Address - Street 2:STE 2400
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:808-432-5760
Mailing Address - Fax:808-432-5759
Practice Address - Street 1:2828 PA A ST
Practice Address - Street 2:STE 2400
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-432-5760
Practice Address - Fax:808-432-5759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0002X
HIPHY-6713336M0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0003XSuppliersPharmacyManaged Care Organization Pharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI58099501Medicaid
2019440OtherPK