MEDICARE: KENDRA RAE BLOOM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	17542	MD

General Provider Information

NPI Number	:	1538895396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENDRA RAE BLOOM DDS

Provider Business Mailing Address
First Line	:	2450 CRAVEN ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92136-5599
Country	:	US
Telephone Number	:	619-556-8240
Fax Number	:

Provider Business Practice Location Address
First Line	:	COMNAVSURFPAC LHA 6 USS AMERICA
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5611
Country	:	US
Telephone Number	:	301-295-0064
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2022
Last Update Date	:	10/07/2025

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