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Licensing details for: 106470

Name: CHAN, CHI LOK TIFFANY

License Type: Dentist

Primary Status: Current - Active

Method of Application: Licensure by WREB

Previous Names: Chan, Chi Lok Tiffany

Address of Record

12621 N. Tatum Blvd
Box 512
PHOENIX AZ 85032
MARICOPA county
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Practice Location

15835 Pomerado Rd
POWAY CA 92064-2073
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4072 Adams Ave
SAN DIEGO CA 92116-2504
SAN DIEGO county
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455 E Columbia St
LONG BEACH CA 90806-1602
LOS ANGELES county
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Issuance Date

July 6, 2021

Expiration Date

August 31, 2026

Current Date / Time

June 6, 2025
8:0:39 PM

License Relationships

PMS 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: Pediatric Minimal Sedation Permit

Name: CHAN, CHI LOK TIFFANY

License/Registration Type: Pediatric Minimal Sedation Permit

License Number: 151 Primary Status: Current - Active

Address :
4072 ADAMS AVE.
SAN DIEGO CA 92116
SAN DIEGO COUNTY

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