Dental Board of California
Licensing details for: 2830
Name: KIM, KELLY YEONSU
License Type: Oral Conscious Sedation
Primary Status: Cancelled
Specialty: Minor
License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MY KIDS DENTIST DENTAL GROUP KIM AND WATANABE DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 15150 Primary Status: Current - Active
Address :
24635 MADISON AVENUE, SUITE E
MURRIETA CA 92562
RIVERSIDE COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MY KID'S DENTIST DENTAL GROUP, KIM AND DO-YABUT DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 16875 Primary Status: Current - Active
Address :
24088 CLINTON KEITH ROAD. SUITE 100
WILDOMAR CA 92595
RIVERSIDE COUNTY
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: MY KID'S DENTIST DENTAL GROUP, KELLY KIM DENTAL CORPORATION
License/Registration Type: Fictitious Name Permit
License Number: 18289 Primary Status: Current - Active
Address :
25100 HANCOCK AVENUE, SUITE 102
MURRIETA CA 92562
RIVERSIDE COUNTY
OCS to DDS, OMS, or SP
License/Registration Role: Oral Conscious Sedation Certificate
Related Party Role: Must hold an active Dental License, Oral Maxillofacial Surgery Permit, or Special Permit
Name: KIM, KELLY YEONSU
License/Registration Type: Dentist License
License Number: 58075 Primary Status: Current - Active
Address :
24088 CLINTON KEITH RD STE 100
WILDOMAR CA 92595
RIVERSIDE COUNTY
