Dental Board of California
Licensing details for: 17179
Name: COASTAL KIDS DENTISTRY SOUTH BAY, DENTAL PRACTICE OF CHIEU PHAM DENTAL CORPORATION
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Previous Names: Chieu Pham Dental Corporation ❖ COASTAL KIDS DENTISTRY SOUTH BAY, DENTAL PRACTICE OF CHIEU PHAN DENTAL CORPORATION
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: PHAM, CHIEU L
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: PHAM, CHIEU L
License/Registration Type: Dentist License
License Number: 52916 Primary Status: Current - Active
Address :
2015 Birch Rd Ste 103
CHULA VISTA CA 91915-2003
SAN DIEGO COUNTY
