Provider Demographics
NPI:1144375056
Name:KAISER FOUNDATION HOSPITALS
Entity type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP AREA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-644-4100
Mailing Address - Street 1:3440 E. LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-2020
Mailing Address - Country:US
Mailing Address - Phone:714-644-2000
Mailing Address - Fax:714-644-4114
Practice Address - Street 1:3440 E. LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2020
Practice Address - Country:US
Practice Address - Phone:714-644-2000
Practice Address - Fax:714-644-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000091282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA339040902OtherUSDOL
CAZZT40609GMedicaid
CA50609OtherBLUE CROSS
CA050609B000000OtherDHS SECTION 1011
CAZZT30609GMedicaid
CAZZZV3011ZOtherBLUE SHIELD
CA=========92807-0000OtherTRICARE
CA050609B000000OtherDHS SECTION 1011
CAW5195Medicare ID - Type UnspecifiedNHIC