Dental Board of California
Licensing details for: 59863
Name: SHIN, SANG GYU
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address of Record
12625 Frederick St
Suite F-4
MORENO VALLEY CA 92553-5216
RIVERSIDE county
Map
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: SHIN & LEE DDS, INC
License/Registration Type: Additional Office Permit
License Number: 81022 Primary Status: Current - Active
Address :
3150 E IMPERIAL HWY, B8-207
LYNWOOD CA 90262
LOS ANGELES 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: PRIMERA DENTAL DENTAL GROUP OF SHIN & LEE DDS, INC
License/Registration Type: Fictitious Name Permit
License Number: 16583 Primary Status: Current - Active
Address :
3150 E IMPERIAL HWY, B8-207
LYNWOOD CA 90262
LOS ANGELES 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: TOWNGATE FAMILY DENTAL AND ORTHODONTICS, DENTAL PRACTICE OF SANG
License/Registration Type: Fictitious Name Permit
License Number: 10856 Primary Status: Current - Active
Address :
12625 FREDERICK STREET SUITE F-4
MORENO VALLEY CA 92553
RIVERSIDE COUNTY
