Provider Demographics
NPI:1659943280
Name:MATTHEW KIM DENTAL CORP
Entity Type:Organization
Organization Name:MATTHEW KIM DENTAL CORP
Other - Org Name:WALNUT PLAZA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-642-9340
Mailing Address - Street 1:903 W CENTER ST STE 5
Mailing Address - Street 2:
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95337-7315
Mailing Address - Country:US
Mailing Address - Phone:209-824-0214
Mailing Address - Fax:209-824-0812
Practice Address - Street 1:903 W CENTER ST STE 5
Practice Address - Street 2:
Practice Address - City:MANTECA
Practice Address - State:CA
Practice Address - Zip Code:95337-7315
Practice Address - Country:US
Practice Address - Phone:209-824-0214
Practice Address - Fax:209-824-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-13
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental