Individual
SPENCER KIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2288 DANIELS ST, MANTECA, CA 95337-6706
(209) 456-5610
Mailing address
2288 DANIELS ST, MANTECA, CA 95337-6706
(808) 384-2707
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DDS111451
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/27/2017
Last updated
07/16/2025
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