Provider Demographics
NPI:1255616280
Name:KAISER
Entity type:Organization
Organization Name:KAISER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIETITIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:TABASSUM
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIR
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:510-481-6319
Mailing Address - Street 1:1440 168TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2409
Mailing Address - Country:US
Mailing Address - Phone:510-481-6319
Mailing Address - Fax:
Practice Address - Street 1:1440 168TH AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2409
Practice Address - Country:US
Practice Address - Phone:510-481-6319
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA943494314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility