Dental Board of California
Licensing details for: 11846
Name: MISSION GROVE DENTISTRY, DENTAL OFFICE OF KYUNG SIN PARK, DDS
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Sole Owner
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: PARK, KYUNGSIN
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: PARK, KYUNGSIN
License/Registration Type: Dentist License
License Number: 56339 Primary Status: Current - Active
Address :
285 E ALESSANDRO BL #7D
RIVERSIDE CA 92508
RIVERSIDE COUNTY
