Dental Board of California
Licensing details for: 58075
Name: KIM, KELLY YEONSU
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
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: KIM AND DO-YABUT DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 81077 Primary Status: Current - Active
Address :
24088 CLINTON KEITH ROAD. SUITE 100
WILDOMAR CA 92595
RIVERSIDE COUNTY
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: KELLY KIM DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 81682 Primary Status: Current - Active
Address :
25100 HANCOCK AVENUE, SUITE 102
MURRIETA CA 92562
RIVERSIDE COUNTY
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: KIM AND WATANABE DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 80183 Primary Status: Current - Active
Address :
24635 MADISON AVENUE, SUITE E
MURRIETA CA 92562
RIVERSIDE COUNTY
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: KIM, KELLY YEONSU
License/Registration Type: Conscious Sedation Permit
License Number: 728 Primary Status: Cancelled
Address :
6764 LOS VERDES DR #6
RANCHO PALOS VERDES CA 90275
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MY KIDS DENTIST DENTAL GROUP KIM AND WATANABE DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 15150 Primary Status: Current - Active
Address :
24635 MADISON AVENUE, SUITE E
MURRIETA CA 92562
RIVERSIDE COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MY KID'S DENTIST DENTAL GROUP, KIM AND DO-YABUT DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 16875 Primary Status: Current - Active
Address :
24088 CLINTON KEITH ROAD. SUITE 100
WILDOMAR CA 92595
RIVERSIDE COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MY KID'S DENTIST DENTAL GROUP, KELLY KIM DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 18289 Primary Status: Current - Active
Address :
25100 HANCOCK AVENUE, SUITE 102
MURRIETA CA 92562
RIVERSIDE 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: MY KID'S DENTIST DENTAL GROUP, KELLY KIM DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 18289 Primary Status: Current - Active
Address :
25100 HANCOCK AVENUE, SUITE 102
MURRIETA CA 92562
RIVERSIDE 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: MY KID'S DENTIST DENTAL GROUP, KIM AND DO-YABUT DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 16875 Primary Status: Current - Active
Address :
24088 CLINTON KEITH ROAD. SUITE 100
WILDOMAR CA 92595
RIVERSIDE 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: MY KIDS DENTIST DENTAL GROUP KIM AND WATANABE DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 15150 Primary Status: Current - Active
Address :
24635 MADISON AVENUE, SUITE E
MURRIETA CA 92562
RIVERSIDE 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, KELLY YEONSU
License/Registration Type: Oral Conscious Sedation Certificate
License Number: 2830 Primary Status: Cancelled
Address :
24088 Clinton Keith Rd
100
WILDOMAR CA 92595-8063
