Provider Demographics
NPI:1851169965
Name:KAISER FOUNDATION HOSPITAL
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITAL
Other - Org Name:KAISER FOUNDATION HOSPITAL AMBULATORY SURGERY CENTER, ANTELOPE VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AREA ADMINISTRATOR/COO
Authorized Official - Prefix:
Authorized Official - First Name:SUZY
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAZAROSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DHED, MTASCP, SBB
Authorized Official - Phone:661-723-2488
Mailing Address - Street 1:615 W AVENUE L
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7211
Mailing Address - Country:US
Mailing Address - Phone:661-723-2488
Mailing Address - Fax:
Practice Address - Street 1:44301 LORIMER AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3700
Practice Address - Country:US
Practice Address - Phone:661-940-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical