Dental Board of California
Licensing details for: 103133
Name: KIM, JIN WAN
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address of Record
408 Hillsborough Blvd
SAN MATEO CA 94402-1126
SAN MATEO county
Map
License Relationships
CS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Conscious Sedation Permit
Name: KIM, JIN WAN
License/Registration Type: Conscious Sedation Permit
License Number: 1320 Primary Status: Cancelled
Address :
770 E Romie Ln
Suite D
SALINAS CA 93901-4222
MS to DDS or OMS or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Moderate Sedation Permit
Name: KIM, JIN WAN
License/Registration Type: Moderate Sedation Permit
License Number: 212 Primary Status: Cancelled
Address :
877 PACIFIC ST. UNIT 100
MONTEREY CA 93940
MONTEREY COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Related Party Role: Oral Conscious Sedation Certificate
Name: KIM, JIN WAN
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 4161 Primary Status: Expired
Address :
3160 CRESSTMOOR DR
SAN BRUNO CA 94066
SAN MATEO COUNTY
