Matthew Kim, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

106312 Issued in CA

Practice address

1101 W Tokay St Ste 2
Lodi, CA 95240-3842

Phone

(209) 334-0760

NPI assigned

Aug 9, 2021

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Matthew Kim DDS Inc

  • Dental Clinic/Center
  • Lodi, CA
  • NPI 1740062736
  NPD Authorized official
• Matthew Kim Dental Corp

  dba Walnut Plaza Dental

  • Dental Clinic/Center
  • Manteca, CA
  • NPI 1659943280
  NPD Authorized official
• Eric Swenson Dental Incorporated

  • Dental Clinic/Center
  • Manteca, CA
  • NPI 1891564993
  NPD (past)

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

{
    "created_epoch": "1628467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1184399529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 W TOKAY ST STE 2",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952403842",
            "telephone_number": "209-334-0760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W TOKAY ST STE 2",
            "city": "LODI",
            "state": "CA",
            "postal_code": "952403842",
            "telephone_number": "209-334-0760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-09",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "106312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ayad Khourdaji, M.D.
• Sophany Khuth
• Valerie J. Kidd, M.D.
• Kids Therapy 4 Success (Lodi Children's Therapy)
• Garrett Thomas Kieffer, DPT
• Robert Kim, MD
• Veronica Kimoto
• Rebecca Kinney
• Rena Yvonne Kiraly, NP
• Mamta Anjali Kissun, PHARMD, RPH

• General Practice Dentistry in Lodi, CA
• Providers in Lodi, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.