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Licensing details for: 65123

Name: KIM, MARIA

License Type: Dentist

Primary Status: Current - Active

Method of Application: Licensure by WREB

Previous Names: KIM, MARIA LEE

Address of Record

15911 Pomona Rincon Rd
120
CHINO HILLS CA 91709
SAN BERNARDINO county
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Contract Location

15911 Pomona Rincon Rd
120
CHINO HILLS CA 91709
SAN BERNARDINO county
Map

Issuance Date

September 15, 2015

Expiration Date

August 31, 2026

Current Date / Time

June 22, 2025
1:6:55 AM

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: PRIYAWAT AND KIM DENTAL SERVICES

License/Registration Type: Additional Office Permit

License Number: 81023 Primary Status: Expired

Address :
444 HARBOR BLVD UNIT 240
FULLERTON CA 92832
ORANGE COUNTY

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FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: OMNIA DENTAL CARE DENTAL OFFICE OF DRS. PRIYAWAT AND KIM

License/Registration Type: Fictitious Name Permit

License Number: 14688 Primary Status: Current - Active

Address :
15911 POMONA RINCON ROAD, UNIT 120
CHINO HILLS CA 91709
SAN BERNARDINO COUNTY

Map

FNP Owners

License/Registration Role: Owners

Related Party Role: Fictitious Name Permit

Name: OMNIA DENTAL CARE DENTAL OFFICE OF PRIYAWAT AND KIM

License/Registration Type: Fictitious Name Permit

License Number: 16565 Primary Status: Current - Active

Address :
444 N. HARBOR BLVD. STE #240
FULLERTON CA 92832
ORANGE COUNTY

Map

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: OMNIA DENTAL CARE DENTAL OFFICE OF DRS. PRIYAWAT AND KIM

License/Registration Type: Fictitious Name Permit

License Number: 14688 Primary Status: Current - Active

Address :
15911 POMONA RINCON ROAD, UNIT 120
CHINO HILLS CA 91709
SAN BERNARDINO COUNTY

Map

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: OMNIA DENTAL CARE DENTAL OFFICE OF PRIYAWAT AND KIM

License/Registration Type: Fictitious Name Permit

License Number: 16565 Primary Status: Current - Active

Address :
444 N. HARBOR BLVD. STE #240
FULLERTON CA 92832
ORANGE COUNTY

Map

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