Basic Information
Provider Information | |||||||||
NPI: | 1134299522 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | KAISER FOUNDATION HOSPITALS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | KAISER FOUNDATION HOSPITAL SAN FRANCISCO | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2425 GEARY BLVD | ||||||||
Address2: |   | ||||||||
City: | SAN FRANCISCO | ||||||||
State: | CA | ||||||||
PostalCode: | 941153358 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4158332000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2425 GEARY BLVD | ||||||||
Address2: |   | ||||||||
City: | SAN FRANCISCO | ||||||||
State: | CA | ||||||||
PostalCode: | 941153358 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4158332000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/09/2006 | ||||||||
LastUpdateDate: | 04/14/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GROEPPER | ||||||||
AuthorizedOfficialFirstName: | RON | ||||||||
AuthorizedOfficialMiddleName: | L | ||||||||
AuthorizedOfficialTitleorPosition: | SR VP, AREA MANAGER | ||||||||
AuthorizedOfficialTelephone: | 4158333258 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 04/14/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 220000188 | CA | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | 50076 | 01 | CA | BLUE CROSS OF CA | OTHER | ZZZA3804Z | 01 | CA | BLUE SHIELD OF CA | OTHER | HSP40076F | 05 | CA |   | MEDICAID | ZZR00076F | 05 | CA |   | MEDICAID | 339040924 | 01 | CA | USDOL | OTHER | 050076B000000 | 01 | CA | SECTION 1011-DHS | OTHER |