Spencer Kim

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DDS111451 Issued in CA

Practice address

2288 Daniels St
Manteca, CA 95337-6706

Phone

(209) 456-5610

NPI assigned

Mar 27, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: spencer.kim.p1@direct.wcchc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Robert P. Nakaki Dental Corporation

  dba Stadium Dental Group

  • General Practice Dentistry
  • Manteca, CA
  • NPI 1841471299
  NPD (past)
• Howard Y Kim DDS Inc

  • Pediatric Dentistry
  • Kailua, HI
  • NPI 1922337765
  NPD (past)

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

{
    "created_epoch": "1490572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1184155400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2288 DANIELS ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953376706",
            "telephone_number": "808-384-2707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2288 DANIELS ST",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953376706",
            "telephone_number": "209-456-5610"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "642 Ulukahiki St Ste 308",
            "address_purpose": "LOCATION",
            "city": "Kailua",
            "state": "HI",
            "postal_code": "967344439",
            "country_code": "US",
            "telephone_number": "808-261-5354",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIM",
        "first_name": "SPENCER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-03-27",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "DDS111451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Balwinder Singh Khosa
• Panthjit Khosa
• Sithavy Khuon
• Jeff B Kim, DDS
• Sarah Jin Kim
• Alexus Cheyenne King-Ferrell
• William J. King, MD
• Kirandeep Kaur DDS Inc (Manteca Smiles Dental)
• Martha Joy Klein, LCSW
• Aiyanna Lenece Kobler

• Pediatric Dentistry in Manteca, CA
• Providers in Manteca, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 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.

Verify at the official NPI Registry.