License Relationships
FNP to DDS or OMS
License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Related Party Role: Fictitious Name Permit
Name: WILSHIRE PARK DENTAL GROUP LA PALMA, KENNY JANG, DDS, INC.
License/Registration Type: Fictitious Name Permit
License Number: 6477 Primary Status: Cancelled
Address :
7872 WALKER STREET
STE. 101
LA PALMA CA 90623
ORANGE COUNTY
