Blossom Hill Dental Clinic

Primary specialty

DentistTaxonomy code 122300000X

License

40751 Issued in CA

Legal business name

BLOSSOM HILL DENTAL CLINIC

Practice address

5460 Dellwood Way Ste a
San Jose, CA 95118-2965

Phone

(408) 266-1117

NPI assigned

Apr 30, 2008

Organization subpart

Yes

Parent organization

RICHMOND DENTAL CAREAs reported in NPPES

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

Authorized official

Name

Mr. Yuri Undorf, DDS

Title

Owner

Phone

(415) 752-5605

Specialties & licenses 1

Addresses

Other identifiers 1

Part of

Richmond Dental Care

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Richmond Dental Care

  • General Practice Dentistry
  • San Francisco, CA
  • NPI 1124144332
  NPPES parent name

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1194991190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5460 DELLWOOD WAY STE A",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951182965",
            "telephone_number": "408-266-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5460 DELLWOOD WAY STE A",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951182965",
            "telephone_number": "408-266-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM HILL DENTAL CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RICHMOND DENTAL CARE",
        "enumeration_date": "2008-04-30",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "UNDORF",
        "authorized_official_first_name": "YURI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "415-752-5605",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CA",
            "license": "40751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTI CAL NUMBER ISSUED FOR OFFICE #1",
            "identifier": "G9111501",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bloom ABA
• Bloom Counseling Services
• Matthew Brandon Bloom, M.D.
• Maelise Blosse
• Blossom Dental Excellence, Inc
• Blossom Valley Eyecare
• Blossom Valley Optometry, Inc (Blossom Valley Eyecare)
• Blossoming Voices
• Andrew Jeremiah Blount
• Blu Transport, LLC (Blu Medical Transport)

• Dentist in San Jose, CA
• Providers in San Jose, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; 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.