Individual
KENNETH JOEL BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
31 COLUMBIA, CPS, ALISO VIEJO, CA 92656-1460
(949) 425-5744
(949) 425-5865
Mailing address
31 COLUMBIA, CPS, ALISO VIEJO, CA 92656-1460
(949) 425-5744
(949) 425-5865
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
G86592
CA
Other
Enumeration date
09/02/2011
Last updated
09/02/2011
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