Basic Information
Provider Information | |||||||||
NPI: | 1063582989 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | KAISER FOUNDATION HOSPITALS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | KAISER FOUNDATION HOSPITAL SAN JOSE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 250 HOSPITAL PKWY | ||||||||
Address2: |   | ||||||||
City: | SAN JOSE | ||||||||
State: | CA | ||||||||
PostalCode: | 951191103 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4089723000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 250 HOSPITAL PKWY | ||||||||
Address2: |   | ||||||||
City: | SAN JOSE | ||||||||
State: | CA | ||||||||
PostalCode: | 951191103 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4089723000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/08/2006 | ||||||||
LastUpdateDate: | 04/20/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | CHAVEZ | ||||||||
AuthorizedOfficialFirstName: | IRENE | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT, AREA MANAGER | ||||||||
AuthorizedOfficialTelephone: | 4089727440 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/20/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 070000117 | CA | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 339040925 | 01 | CA | USDOL | OTHER | 50604 | 01 | CA | BLUE CROSS OF CA | OTHER | HSP40604G | 05 | CA |   | MEDICAID | 050604B000000 | 01 | CA | SECTION 1011-DHS | OTHER | ZZR00604G | 05 | CA |   | MEDICAID | ZZZA4312Z | 01 | CA | BLUE SHIELD OF CA | OTHER |