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Licensing details for: 11127

Name: ALAMITOS ORAL SURGERY, DENTAL OFFICE OF DRS. POYOUROW, CHANDRA, A

License Type: Fictitious Name Permit

Primary Status: Expired Primary Status Definition

Organization Classification: Partnership

Previous Names: ALAMITOS ORAL SURGERY DENTAL OFFICE OF DRS. POYOUROW, CHANDRA, AND PHAM

Address of Record

4582 KATELLA AVENUE
LOS ALAMITOS CA 90720
ORANGE county
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Practice Location

4582 KATELLA AVENUE
LOS ALAMITOS CA 90720
ORANGE county
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Issuance Date

March 7, 2014

Expiration Date

September 30, 2022

Current Date / Time

June 6, 2025
2:1:57 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: PHAM, LEE DUONG

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: POYOUROW, SOLOMON LOUIS RIKMAR

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: CHANDRA, HEENA JAI

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: POYOUROW, SOLOMON LOUIS RIKMAR

License/Registration Type: Dentist License

License Number: 56129 Primary Status: Current - Active

Address :
1441 Avocado Ave Ste 406
NEWPORT BEACH CA 92660-7705
ORANGE COUNTY

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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: PHAM, LEE DUONG

License/Registration Type: Dentist License

License Number: 55453 Primary Status: Current - Active

Address :
4582 KATELLA AVENUE
LOS ALAMITOS CA 90720
ORANGE COUNTY

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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: CHANDRA, HEENA JAI

License/Registration Type: Dentist License

License Number: 58092 Primary Status: Current - Active

Address :
4582 Katella Ave
LOS ALAMITOS CA 90720
ORANGE COUNTY

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