Dental Board of California
Licensing details for: 11486
Name: NORTH SAN DIEGO ENDODONTICS, DENTAL PRACTICE OF KI WAN KIM, D.D.S
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KIM, KI WAN
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: KIM, KI WAN
License/Registration Type: Dentist License
License Number: 63507 Primary Status: Current - Active
Address :
3601 Vista Way
Suite 202
OCEANSIDE CA 92056-4559
SAN DIEGO COUNTY
