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Licensing details for: 79160

Name: KRYSTAL PHAM DDS, INC.

License Type: Additional Office Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

17991 Euclid St
FOUNTAIN VALLEY CA 92708-5409
ORANGE county
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Practice Location

17991 Euclid St
FOUNTAIN VALLEY CA 92708-5409
ORANGE county
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Issuance Date

November 23, 2016

Expiration Date

December 31, 2025

Current Date / Time

June 6, 2025
11:45:3 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, KRYSTAL HONG-QUYEN

License/Registration Type: Dentist License

License Number: 57473 Primary Status: Current - Active

Address :
16052 BEACH BLVD
STE 112
HUNTINGTON BEACH CA 92647
ORANGE COUNTY

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