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General NPI Number Information
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NPI Number | 1538895396
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Entity Type | Individual
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Provider Name | KENDRA RAE BLOOM DDS
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Gender | Female
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | COMNAVSURFPAC LHA 6 USS AMERICA
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City | SAN DIEGO
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State | CA
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Zip | 92155-5611
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Country | US
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Telephone | 301-295-0064
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Fax |
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Provider Business Mailing Address
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Address Line | 2450 CRAVEN ST
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City | SAN DIEGO
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State | CA
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Zip | 92136-5599
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Country | US
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Telephone | 619-556-8240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 17542
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License Number State | MD
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