NPIMap

Organization Active NPI

Kaiser Foundation Health Plan Inc

  • Community/Retail Pharmacy
  • Antioch, CA
National Provider Identifier
1376691253
Registry record updated Apr 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY32380 Issued in CA
Legal business name
KAISER FOUNDATION HEALTH PLAN INC
Practice address
3400 Delta Fair Blvd
Antioch, CA 94509-4004
Phone
(925) 779-5173
Fax
(925) 779-5465
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Kvancz
Title
VP Nat'L Phrmcy Prog & SVCS
Phone
(562) 658-3510

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X PHY32380 CA Primary

Addresses

Primary practice location

3400 Delta Fair Blvd
Antioch, CA 94509-4004

Mailing address

3400 Delta Fair Blvd
Antioch, CA 94509-4004

Other identifiers 2

IdentifierTypeStateIssuer
0528325OtherNCPDP PROVIDER IDENTIFICATION NUMBER
PHA323800MedicaidCA

Other names 1

  • KAISER HEALTH PLAN MAIN PHY 551 Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kaiser FDN HLTH Plan Phcy379 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334102400000",
    "number": "1376691253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 DELTA FAIR BLVD",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945094004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 DELTA FAIR BLVD",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945094004",
            "telephone_number": "925-779-5173",
            "fax_number": "925-779-5465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2012-04-11",
        "status": "A",
        "authorized_official_last_name": "KVANCZ",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP NAT'L PHRMCY PROG & SVCS",
        "authorized_official_telephone_number": "562-658-3510"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY32380",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0528325",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA323800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KAISER HEALTH PLAN MAIN PHY 551",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Antioch, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.