Basic Information
Provider Information | |||||||||
NPI: | 1134274897 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | KAISER FOUNDATION HOSPITALS | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | KAISER FOUNDATION HOSPITAL WEST LOS ANGELES | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6041 CADILLAC AVE | ||||||||
Address2: |   | ||||||||
City: | LOS ANGELES | ||||||||
State: | CA | ||||||||
PostalCode: | 900341702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3238572000 | ||||||||
FaxNumber: | 3238572039 | ||||||||
Practice Location | |||||||||
Address1: | 6041 CADILLAC AVE | ||||||||
Address2: |   | ||||||||
City: | LOS ANGELES | ||||||||
State: | CA | ||||||||
PostalCode: | 900341702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3238572000 | ||||||||
FaxNumber: | 3238572039 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/24/2007 | ||||||||
LastUpdateDate: | 06/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | ZIBARI | ||||||||
AuthorizedOfficialFirstName: | LILIT | ||||||||
AuthorizedOfficialMiddleName: | S | ||||||||
AuthorizedOfficialTitleorPosition: | SVP/AREA MANAGER | ||||||||
AuthorizedOfficialTelephone: | 3238573618 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MRS. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/21/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 930000081 | CA | Y |   | Hospitals | General Acute Care Hospital |   |
ID Information
ID | Type | State | Issuer | Description | ZZZA1982Z | 01 | CA | BLUE SHIELD | OTHER | ZZT31414F | 05 | CA |   | MEDICAID | ZZT41414F | 05 | CA |   | MEDICAID | 50561 | 01 | CA | BLUE CROSS | OTHER | 050561B000000 | 01 | CA | DHS SECTION 1011 | OTHER | 339040907 | 01 | CA | USDOL | OTHER |