Myron J Bloom, MD

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

G17159 Issued in CA

Practice address

3801 Katella Ave
Suite 212
Los Alamitos, CA 90720-3381

Phone

(562) 596-4645

Fax

(562) 596-2225

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881608370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 KATELLA AVE",
            "address_2": "SUITE 212",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203381",
            "telephone_number": "562-596-4645",
            "fax_number": "562-596-2225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 KATELLA AVE",
            "address_2": "SUITE 212",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203381",
            "telephone_number": "562-596-4645",
            "fax_number": "562-596-2225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "MYRON",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "G17159",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G171590",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blackburn WC DMD
• Richard Blackburn, DMD
• Stan R. Blackwell, A.B.O.C.
• Blessed Palliative and Hospice Service
• Wendy Nan Block, L.C.S,W.
• Lawrence Neil Blum, PHD
• Melanie J Blumenthal, MD
• Richard A Blumenthal, MD
• Brianna Elizabeth Bobadilla
• Gene L Bohlmann, ED.D.

• Plastic and Reconstructive Surgery Physician in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Plastic and Reconstructive Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.