Dental Board of California
Licensing details for: 1040
Name: VAN NESS DENTAL GROUP
License Type: Fictitious Name Permit
Primary Status: Expired
Organization Classification: Corporation
Address of Record
CHARLES NIP DDS, INC.
2243 VAN NESS AVE STE 101
SAN FRANCISCO CA 94109
SAN FRANCISCO county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: YEE, KIRBY MAN-YIN
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: JA, ALEXANDER
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: FONG, CLARK LEONG
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: NIP, GREGORY CHARLES
Address Not Disclosed
FNP to DDS or OMS
License/Registration Role: Fictitious Name Permit
Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Name: JA, ALEXANDER
License/Registration Type: Dentist License
License Number: 31805 Primary Status: Current - Active
Address :
2243 Van Ness Ave Ste 101
SAN FRANCISCO CA 94109-2504
SAN FRANCISCO COUNTY
FNP to DDS or OMS
License/Registration Role: Fictitious Name Permit
Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Name: YEE, KIRBY MAN-YIN
License/Registration Type: Dentist License
License Number: 41227 Primary Status: Current - Active
Address :
912 GRAND AVENUE, SUITE #101
SAN RAFAEL CA 94901
MARIN COUNTY
FNP to DDS or OMS
License/Registration Role: Fictitious Name Permit
Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Name: FONG, CLARK LEONG
License/Registration Type: Dentist License
License Number: 40351 Primary Status: Current - Active
Address :
401A N San Mateo Dr
SAN MATEO CA 94401-2417
SAN MATEO COUNTY
FNP to DDS or OMS
License/Registration Role: Fictitious Name Permit
Related Party Role: Must hold an active Dental License, or Oral Maxillofacial Surgery Permit
Name: NIP, GREGORY CHARLES
License/Registration Type: Dentist License
License Number: 40382 Primary Status: Current - Active
Address :
3749 NORIEGA
SAN FRANCISCO CA 94122
SAN FRANCISCO COUNTY
