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Licensing details for: 4161

Name: KIM, JIN WAN

License Type: Oral Conscious Sedation

Primary Status: Expired Primary Status Definition

Specialty: Adult

Address of Record

3160 CRESSTMOOR DR
SAN BRUNO CA 94066
SAN MATEO county
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Issuance Date

August 5, 2021

Expiration Date

July 31, 2023

Current Date / Time

December 13, 2025
9:49:13 AM

License Relationships

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, JIN WAN

License/Registration Type: Dentist License

License Number: 103133 Primary Status: Current - Active

Address :
408 Hillsborough Blvd
SAN MATEO CA 94402-1126
SAN MATEO COUNTY

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