Provider Demographics
NPI:1962724856
Name:KAISER FOUNDATION HOSPITALS
Entity type:Organization
Organization Name:KAISER FOUNDATION HOSPITALS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MILLER-PHIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-279-4100
Mailing Address - Street 1:17542 EAST 17TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1960
Mailing Address - Country:US
Mailing Address - Phone:714-734-4500
Mailing Address - Fax:714-734-7570
Practice Address - Street 1:17542 EAST 17TH STREET
Practice Address - Street 2:SUITE 300
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1960
Practice Address - Country:US
Practice Address - Phone:714-734-4500
Practice Address - Fax:714-734-7570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000015251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA551634Medicare Oscar/Certification