Kaiser Foundation Health Plan Inc
Organization Active NPI Community/Retail Pharmacy · San Bruno, CA
NPI 1003963331 · NPPES record last updated Nov 24, 2020
Key facts
- NPI
- 1003963331
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHY38292 (CA)
- Legal business name
- KAISER FOUNDATION HEALTH PLAN INC
- Practice address
- 801 Traeger Ave
San Bruno, CA 94066-3048 - Phone
- (650) 742-2388
- Fax
- (650) 742-2567
- NPI assigned
- Jan 5, 2007
- Organization subpart
- No
Authorized official
- Name
- Kathryn Renouard Brown
- Title
- VP Pharmacy Operations and Services
- Phone
- (510) 625-2363
Corporate family (same tax ID) 13
National Provider Directory
- Tax ID family
- Kaiser FDN HLTH Plan Phcy
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PHY38292 | CA | Yes |
Addresses
Primary practice location
801 Traeger Ave
San Bruno, CA 94066-3048
Mailing address
1800 Harrison St FL 13
Oakland, CA 94612-3466
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0566022 | Other | NCPDP PROVIDER IDENTIFICATION NUMBER | |
| PHA382920 | Medicaid | CA |
Other names
- KAISER HEALTH PLAN BAYHILL PHARMACY 353
NPI Registry JSON
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1606176000000",
"number": "1003963331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 HARRISON ST FL 13",
"city": "OAKLAND",
"state": "CA",
"postal_code": "946123466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 TRAEGER AVE",
"city": "SAN BRUNO",
"state": "CA",
"postal_code": "940663048",
"telephone_number": "650-742-2388",
"fax_number": "650-742-2567"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KAISER FOUNDATION HEALTH PLAN INC",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-05",
"last_updated": "2020-11-24",
"certification_date": "2020-11-24",
"status": "A",
"authorized_official_last_name": "BROWN",
"authorized_official_first_name": "KATHRYN",
"authorized_official_middle_name": "RENOUARD",
"authorized_official_title_or_position": "VP PHARMACY OPERATIONS AND SERVICES",
"authorized_official_telephone_number": "510-625-2363"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "CA",
"license": "PHY38292",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
"identifier": "0566022",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PHA382920",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "KAISER HEALTH PLAN BAYHILL PHARMACY 353",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "KAISER HEALTH PLAN BAYHILL PHARMACY 353",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in San Bruno, CA
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- Mariela Juarez
- Regina Juarez
- Keala Kaeo
- Kaiser Foundation Health Plan Inc
- Hannah Kang
- Amy Wan-Ju Kao
- Rebecca Kaplan-Rahimzadeh
- Courtney Ann Karley
All providers in San Bruno, CA · Community/Retail Pharmacy in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.