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Licensing details for: 57783

Name: LEE, SHAWN

License Type: Dentist

Primary Status: Current - Active

Method of Application: Licensure by WREB

Address of Record

62 SYCAMORE BEND
IRVINE CA 92620
ORANGE county
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Practice Location

28901 S WESTERN AVE STE. 135
RANCHO PALOS VERDES CA 90275
LOS ANGELES county
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Issuance Date

October 1, 2008

Expiration Date

December 31, 2025

Current Date / Time

June 6, 2025
3:54:12 PM

License Relationships

AO to DDS or OMS (Owners)

License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Related Party Role: Additional Office Permit

Name: SHAWN LEE, DDS

License/Registration Type: Additional Office Permit

License Number: 82243 Primary Status: Current - Active

Address :
560 Pine Avenue
LONG BEACH CA 90802

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AO to DDS or OMS (Owners)

License/Registration Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit

Related Party Role: Additional Office Permit

Name: Shawn lee and manoranjani sambangi dental corporation

License/Registration Type: Additional Office Permit

License Number: 79036 Primary Status: Cancelled

Address :
28901 S Western Ave
SUITE 135
RANCHO PALOS VERDES CA 90275-0828
LOS ANGELES COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: RANCHO PALOS VERDES DENTISTRY DENTAL GROUP SHAWN LEE AND MANORANJANI SAMBANGI DENTAL CORPORATION

License/Registration Type: Fictitious Name Permit

License Number: 12928 Primary Status: Current - Active

Address :
28901 S. WESTERN AVENUE, SUITE 135
RANCHO PALOS VERDES CA 90275
LOS ANGELES COUNTY

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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: RANCHO PALOS VERDES DENTISTRY DENTAL GROUP SHAWN LEE AND MANORANJANI SAMBANGI DENTAL CORPORATION

License/Registration Type: Fictitious Name Permit

License Number: 12928 Primary Status: Current - Active

Address :
28901 S. WESTERN AVENUE, SUITE 135
RANCHO PALOS VERDES CA 90275
LOS ANGELES COUNTY

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