Provider Demographics
NPI:1366513509
Name:KAISER FOUNDATION HOSPITALS
Entity type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT/AREA MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NORAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:JEMJEMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-651-5414
Mailing Address - Street 1:975 SERENO DR
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94589-2441
Mailing Address - Country:US
Mailing Address - Phone:707-651-1000
Mailing Address - Fax:
Practice Address - Street 1:975 SERENO DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-2441
Practice Address - Country:US
Practice Address - Phone:707-651-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-10
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110000026282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR00073FMedicaid
CA339040909OtherUSDOL
CA50073OtherBLUE CROSS OF CA
CAZZZA4801ZOtherBLUE SHIELD OF CA
CA050073B000000OtherSECTION 1011 - DHS
CAHSP40073FMedicaid
CA=========94589-0000OtherTRICARE
CAZZR00073FMedicaid
CAHSP40073FMedicaid