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Licensing details for: 11806

Name: CHIEU PHAM DDS INC

License Type: Additional Office Permit

Primary Status: Cancelled

Organization Classification: Corporation

Address of Record

12395 EL CAMINO ROAD #312
SAN DIEGO CA 92130
SAN DIEGO county
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Practice Location

12395 EL CAMINO ROAD
#312
SAN DIEGO CA 92130
SAN DIEGO county
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Issuance Date

March 30, 2015

Expiration Date

August 31, 2017

Current Date / Time

December 13, 2025
5:23:39 PM

License Relationships

AO to DDS or OMS (Owners)

License/Registration Role: Additional Office Permit

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

Name: PHAM, CHIEU L

License/Registration Type: Dentist License

License Number: 52916 Primary Status: Current - Active

Address :
2015 Birch Rd Ste 103
CHULA VISTA CA 91915-2003
SAN DIEGO COUNTY

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