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Licensing details for: 13517

Name: PERRIS MODERN DENTISTRY DENTAL GROUP SOHAL AND PHAM DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

1820 PERRIS BLVD STE 70
PERRIS CA 92571
RIVERSIDE county
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Practice Location

1820 PERRIS BLVD STE 70
PERRIS CA 92571
RIVERSIDE county
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Issuance Date

May 12, 2017

Expiration Date

July 31, 2026

Current Date / Time

June 6, 2025
2:8:18 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: DHAMA, DEEPIKA S

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: DO YABUT, DIANA SONG

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: SOHAL, SHERLY S

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: PHAM, MINH BAO

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: LEE, FREDERICK HYUN WOO

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: DHAMA, DEEPIKA S

License/Registration Type: Dentist License

License Number: 49044 Primary Status: Current - Active

Address :
2044 California Ave
CORONA CA 92881-3300
RIVERSIDE 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: SOHAL, SHERLY S

License/Registration Type: Dentist License

License Number: 59799 Primary Status: Current - Active

Address :
27001 Moulton Pkwy
ste a-118
LAGUNA HILLS CA 92656-3600
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: LEE, FREDERICK HYUN WOO

License/Registration Type: Dentist License

License Number: 43359 Primary Status: Current - Active

Address :
4000 W. FLORIDA AVE.
HEMET CA 92545
RIVERSIDE 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: DO YABUT, DIANA SONG

License/Registration Type: Dentist License

License Number: 53903 Primary Status: Current - Active

Address :
20201 CHIANTI COURT
YORBA LINDA CA 92886
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, MINH BAO

License/Registration Type: Dentist License

License Number: 46321 Primary Status: Expired

Address :
5675 Balboa Ave
SAN DIEGO CA 92111-2705
SAN DIEGO COUNTY

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