Provider Demographics
NPI:1790223212
Name:KAISER
Entity Type:Organization
Organization Name:KAISER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:QUYNHHUONG
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:DAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-516-6223
Mailing Address - Street 1:4405 VANDEVER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-3315
Mailing Address - Country:US
Mailing Address - Phone:619-516-6223
Mailing Address - Fax:619-516-7711
Practice Address - Street 1:4405 VANDEVER AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-3315
Practice Address - Country:US
Practice Address - Phone:619-516-6223
Practice Address - Fax:619-516-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY46253284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital