Dental Board of California
Licensing details for: 62792
Name: LA-PHAM, KINH
License Type: Dentist
Primary Status: Current - Active
Method of Application: Licensure by WREB
Address of Record
4578 Atlantic Ave
LONG BEACH CA 90807-1513
LOS ANGELES 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: LA-PHAM AND KANSAGRA DENTAL CORPORATION
License/Registration Type: Additional Office Permit
License Number: 79542 Primary Status: Current - Active
Address :
4578 ATLANTIC AVE
LONG BEACH CA 90807
LOS ANGELES COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: BIXBY KNOLLS MODERN DENTISTRY DENTAL GROUP, LA-PHAM AND KANSAGRA DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 13925 Primary Status: Current - Active
Address :
4578 ATLANTIC AVE
LONG BEACH CA 90807
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: BIXBY KNOLLS MODERN DENTISTRY DENTAL GROUP, LA-PHAM AND KANSAGRA DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 13925 Primary Status: Current - Active
Address :
4578 ATLANTIC AVE
LONG BEACH CA 90807
LOS ANGELES COUNTY
