Dental Board of California
Licensing details for: 51348
Name: KIM, SAMUEL I
License Type: Dentist
Primary Status: Current - Active
Address of Record
17768 Wika Rd # 100
APPLE VALLEY CA 92307-1200
SAN BERNARDINO county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: APPLE VALLEY DENTAL OFFICE
License/Registration Type: Fictitious Name Permit
License Number: 13144 Primary Status: Current - Active
Address :
17768 Wika Road
Suite 100
APPLE VALLEY CA 92307
SAN BERNARDINO COUNTY
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: APPLE VALLEY DENTAL OFFICE, SAMUEL KIM, DDS, INC.
License/Registration Type: Fictitious Name Permit
License Number: 5435 Primary Status: Cancelled
Address :
21580 BEAR VALLEY RD, STE B2-2
APPLE VALLEY CA 92308
SAN BERNARDINO COUNTY
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: APPLE VALLEY DENTAL OFFICE
License/Registration Type: Fictitious Name Permit
License Number: 13144 Primary Status: Current - Active
Address :
17768 Wika Road
Suite 100
APPLE VALLEY CA 92307
SAN BERNARDINO 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, SAMUEL I
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 3615 Primary Status: Current - Active
Address :
17768 WIKA ROAD #100
APPLE VALLEY CA 92307
SAN BERNARDINO COUNTY
