Provider Demographics
NPI:1124883756
Name:BLOSSOM PEDIATRICS, PLLC
Entity type:Organization
Organization Name:BLOSSOM PEDIATRICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HUAN
Authorized Official - Middle Name:THO
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:281-509-9999
Mailing Address - Street 1:10680 JONES RD STE 2000
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5702
Mailing Address - Country:US
Mailing Address - Phone:281-509-9999
Mailing Address - Fax:
Practice Address - Street 1:10680 JONES RD STE 2000
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5702
Practice Address - Country:US
Practice Address - Phone:281-509-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty