Basic Information
| Provider Information | |||||||||
| NPI: | 1376698043 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KAISER FOUNDATION HOSPITALS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | KAISER FOUNDATION HOSPITAL PANORAMA CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 13652 CANTARA ST | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914025423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183752131 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13652 CANTARA ST | ||||||||
| Address2: | |||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914025423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183752000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 04/14/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ROSHAN | ||||||||
| AuthorizedOfficialFirstName: | PAYMAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8183752131 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 930000080 | CA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | ZZT40137F | 05 | CA | MEDICAID | ZZT30137F | 05 | CA | MEDICAID | 050137B000000 | 01 | CA | DHS SECTION 1011 | OTHER | 339040906 | 01 | CA | USDOL | OTHER | ZZZA1940Z | 01 | CA | BLUE SHIELD | OTHER | 50137 | 01 | CA | BLUE CROSS | OTHER |