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Licensing details for: 1200

Name: KIM, JEKYONG JAY

License Type: Conscious Sedation

Primary Status: Cancelled

Address of Record

100 CALYPSO LANE
MILPITAS CA 95035
SANTA CLARA county
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Practice Location

2998 EL CAMINO REAL, UNIT 200
SANTA CLARA CA 95051
SANTA CLARA county
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Issuance Date

July 2, 2019

Expiration Date

August 31, 2020

Current Date / Time

June 6, 2025
1:53:59 AM

License Relationships

CS to DDS, OMS, or SP

License/Registration Role: Conscious Sedation Permit

Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit

Name: KIM, JEKYONG JAY

License/Registration Type: Dentist License

License Number: 62259 Primary Status: Current - Active

Address :
930 Sunnyslope Rd
Suite B-3
HOLLISTER CA 95023
SAN BENITO COUNTY

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