Provider Demographics
NPI:1942463419
Name:KAISER PERMENANTE
Entity Type:Organization
Organization Name:KAISER PERMENANTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:YEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-658-0878
Mailing Address - Street 1:2431 BUCKINGHAM LN
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1335
Mailing Address - Country:US
Mailing Address - Phone:310-658-0878
Mailing Address - Fax:
Practice Address - Street 1:6041 CADILLAC AVE
Practice Address - Street 2:FAMILY MEDICINE/AAH
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1335
Practice Address - Country:US
Practice Address - Phone:800-954-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-05
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76751302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization