Bonsai Health

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

BONSAI HEALTH

Practice address

16766 Bernardo Center Dr Ste 206
San Diego, CA 92128-2502

Phone

(858) 381-0686

Fax

(858) 365-5189

NPI assigned

Mar 20, 2023

Organization subpart

No

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

Authorized official

Name

Sucharita Boddu, MDNPI 1679968705

Title

Owner

Phone

(973) 563-6064

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sucharita Boddu, M.D.

  • Dermatology Physician
  • San Diego, CA
  • NPI 1679968705
  Medicare reassignment Authorized official
• Chirag M Shah, M.D., MPH

  • Retina Specialist (Ophthalmology) Physician
  • San Diego, CA
  • NPI 1023472560
  NPD

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

{
    "created_epoch": "1679270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679270400000",
    "number": "1801598107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16766 BERNARDO CENTER DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282545",
            "telephone_number": "858-381-0686",
            "fax_number": "858-365-5189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16766 BERNARDO CENTER DR STE 206",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282502",
            "telephone_number": "858-381-0686",
            "fax_number": "858-365-5189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONSAI HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-20",
        "last_updated": "2023-03-20",
        "certification_date": "2023-03-20",
        "status": "A",
        "authorized_official_last_name": "BODDU",
        "authorized_official_first_name": "SUCHARITA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-563-6064",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sierra Bonner, OTD, OTR/L
• Ralph Bonnett
• Justine Michelle Bono Foltz, NP
• Erica Bono, PHARMD
• Sarah Ann Bonomi
• Princess Joanne Bonsol
• Emily Bontrager, MD
• Bonus Round Recovery Inc
• Rockey Diagon Booc, IDC
• Kermit Rex Booher, M.D.

• Dermatology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.