Matthew Kim Dental Corp

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

MATTHEW KIM DENTAL CORP

Practice address

903 W Center St Ste 5
Manteca, CA 95337-7315

Phone

(209) 824-0214

Fax

(209) 824-0812

NPI assigned

Jul 13, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Matthew Kim, DDSNPI 1184399529

Title

Ceo

Phone

(209) 642-9340

Specialties & licenses 1

Addresses

Other names 1

• Walnut Plaza Dental Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew Kim, DDS

  • General Practice Dentistry
  • Lodi, CA
  • NPI 1184399529
  NPD Authorized official
• Eric Swenson, DDS

  • Dentist
  • Manteca, CA
  • NPI 1619540267
  NPD
• Wilner Clifford Cacho, DDS

  • General Practice Dentistry
  • Manteca, CA
  • NPI 1225143829
  NPD (past)

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

{
    "created_epoch": "1626134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660780800000",
    "number": "1659943280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 W CENTER ST STE 5",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953377315",
            "telephone_number": "209-824-0214",
            "fax_number": "209-824-0812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 W CENTER ST STE 5",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953377315",
            "telephone_number": "209-824-0214",
            "fax_number": "209-824-0812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW KIM DENTAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-13",
        "last_updated": "2022-08-18",
        "certification_date": "2022-08-18",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "209-642-9340",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walnut Plaza Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Walnut Plaza Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Annie Mathew, PHARMD
• Reba Anil Mathew
• Anita Biju Mathews, D.M.D.
• Catherine F Mathis, M.D.
• Michael Ross Matson, DDS
• Brianna Maxey
• Jade Hannah McBride
• Teresa McClendon
• Cassandra June McCurdy, MSN,NP-C
• Jeffrey O McGillicuddy, MD

• Dental Clinic/Center in Manteca, CA
• Providers in Manteca, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2022; 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.