Dental Board of California
Licensing details for: 3615
Name: KIM, SAMUEL I
License Type: Oral Conscious Sedation
Primary Status: Current - Active
Specialty: Adult
Address of Record
17768 WIKA ROAD #100
APPLE VALLEY CA 92307
SAN BERNARDINO county
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License Relationships
FNP Owners
License/Registration Role: Owners
Related Party Role: Fictitious Name Permit
Name: APPLE VALLEY DENTAL OFFICE
License/Registration Type: Fictitious Name Permit
License Number: 13144 Primary Status: Current - Active
Address :
17768 Wika Road
Suite 100
APPLE VALLEY CA 92307
SAN BERNARDINO 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, SAMUEL I
License/Registration Type: Dentist License
License Number: 51348 Primary Status: Current - Active
Address :
17768 Wika Rd # 100
APPLE VALLEY CA 92307-1200
SAN BERNARDINO COUNTY
