Active NPI
Robert Malonso, DMD
- Dentist
- San Jose, CA
National Provider Identifier
1790906105
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 49587
- Practice address
- 4095 Evergreen Village SQ Ste 120
San Jose, CA 95135-1747 - Phone
- (408) 528-0530
- Fax
- (408) 528-0533
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 49587 | CA | Primary |
| General Practice Dentistry | 1223G0001X | 49587 | CA |
Addresses
Primary practice location
4095 Evergreen Village SQ Ste 120
San Jose, CA 95135-1747
Mailing address
4095 Evergreen Village SQ Ste 120
San Jose, CA 95135-1747
Phone (408) 528-0530
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49587 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1790906105",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4095 EVERGREEN VILLAGE SQ STE 120",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951351747",
"telephone_number": "408-528-0530",
"fax_number": "408-528-0533"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4095 EVERGREEN VILLAGE SQ STE 120",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951351747",
"telephone_number": "408-528-0530",
"fax_number": "408-528-0533"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALONSO",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-01",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "49587",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "49587",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.