Dental Board of California
Licensing details for: 1575
Name: PALMDALE MARKETPLACE DENTAL GROUP
License Type: Fictitious Name Permit
Primary Status: Cancelled
Organization Classification: Sole Owner
Address of Record
4654 E AVENUE S #A
PALMDALE CA 93552
LOS ANGELES county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: CHO, ARNOLD TAE HEE
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: AZANI, DANIEL
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: KO, SAMUEL HYUNWOOK
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: CHO, ARNOLD TAE HEE
License/Registration Type: Dentist License
License Number: 40067 Primary Status: Expired
Address :
630 S. SHATTO PL. 1ST FL.
LOS ANGELES CA 90005
LOS ANGELES 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: KO, SAMUEL HYUNWOOK
License/Registration Type: Dentist License
License Number: 40454 Primary Status: Current - Active
Address :
12429 MARIPOSA RD. SUITE A
VICTORVILLE CA 92395
SAN BERNARDINO 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: AZANI, DANIEL
License/Registration Type: Dentist License
License Number: 34051 Primary Status: Current - Active
Address :
27421 Tourney Rd
180
VALENCIA CA 91355-5645
LOS ANGELES COUNTY
