Dental Board of California
Licensing details for: 63507
Name: KIM, KI WAN
License Type: Dentist
Primary Status: Current - Active
Secondary Status: Licensure by Residency
Method of Application: Licensure by Residency
Address of Record
3601 Vista Way
Suite 202
OCEANSIDE CA 92056-4559
SAN DIEGO county
Map
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: NORTH SAN DIEGO ENDODONTICS, DENTAL PRACTICE OF KI WAN KIM, D.D.S
License/Registration Type: Fictitious Name Permit
License Number: 11486 Primary Status: Current - Active
Address :
3601 VISTA WAY #202
OCEANSIDE CA 92056
SAN DIEGO 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: NORTH SAN DIEGO ENDODONTICS, DENTAL PRACTICE OF KI WAN KIM, D.D.S
License/Registration Type: Fictitious Name Permit
License Number: 11486 Primary Status: Current - Active
Address :
3601 VISTA WAY #202
OCEANSIDE CA 92056
SAN DIEGO COUNTY
