Provider Demographics
NPI:1740062736
Name:MATTHEW KIM DDS INC
Entity type:Organization
Organization Name:MATTHEW KIM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-334-0760
Mailing Address - Street 1:1101 W TOKAY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3842
Mailing Address - Country:US
Mailing Address - Phone:209-334-0760
Mailing Address - Fax:
Practice Address - Street 1:1101 W TOKAY ST STE 2
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3842
Practice Address - Country:US
Practice Address - Phone:209-334-0760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental