Provider Demographics
NPI:1922153865
Name:KAISER FOUNDATION HOSPITALS
Entity Type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:KAISER FOUNDATION HOSPITAL ANAHEIM ESRD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP AREA MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-279-4100
Mailing Address - Street 1:3460 E LA PALMA AVE
Mailing Address - Street 2:3RD FLOOR, SUITE 3132
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2020
Mailing Address - Country:US
Mailing Address - Phone:714-664-2440
Mailing Address - Fax:714-664-2455
Practice Address - Street 1:3460 E LA PALMA AVE
Practice Address - Street 2:3RD FLOOR, SUITE 3132
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2020
Practice Address - Country:US
Practice Address - Phone:714-664-2440
Practice Address - Fax:714-664-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000091261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA052394Medicare Oscar/Certification