Dental Board of California
Licensing details for: 55453
Name: PHAM, LEE DUONG
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address of Record
4582 KATELLA AVENUE
LOS ALAMITOS CA 90720
ORANGE 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: PHAM, LEE DUONG
License/Registration Type: Conscious Sedation Permit
License Number: 566 Primary Status: Cancelled
Address :
26182 ERIN CT
LAKE FOREST CA 92630
ORANGE COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: COSTA MESA ORAL SURGERY DENTAL PRACTICE OF LEE D. PHAM, DDS, MD, INC. AND HEENA CHANDRA, DDS, INC.
License/Registration Type: Fictitious Name Permit
License Number: 16528 Primary Status: Current - Active
Address :
2900 BRISTOL STREET SUITE D101
COSTA MESA CA 92626
ORANGE COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: ALAMITOS ORAL SURGERY, DENTAL OFFICE OF DRS. POYOUROW, CHANDRA, A
License/Registration Type: Fictitious Name Permit
License Number: 11127 Primary Status: Expired
Address :
4582 KATELLA AVENUE
LOS ALAMITOS CA 90720
ORANGE 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: COSTA MESA ORAL SURGERY DENTAL PRACTICE OF LEE D. PHAM, DDS, MD, INC. AND HEENA CHANDRA, DDS, INC.
License/Registration Type: Fictitious Name Permit
License Number: 16528 Primary Status: Current - Active
Address :
2900 BRISTOL STREET SUITE D101
COSTA MESA CA 92626
ORANGE 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: ALAMITOS ORAL SURGERY, DENTAL OFFICE OF DRS. POYOUROW, CHANDRA, A
License/Registration Type: Fictitious Name Permit
License Number: 11127 Primary Status: Expired
Address :
4582 KATELLA AVENUE
LOS ALAMITOS CA 90720
ORANGE COUNTY
GA 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: General Anesthesia Permit
Name: PHAM, LEE DUONG
License/Registration Type: General Anesthesia Permit
License Number: 1625 Primary Status: Current - Active
Address :
2900 Bristol Street
Suite D101
COSTA MESA CA 92626
ORANGE COUNTY
