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Licensing details for: 17644

Name: DENTISTS OF SAN JACINTO DENTAL GROUP, JUSTIN NAMM DENTAL CORPORATION

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Address of Record

1221 STATE ST SUITE D
SAN JACINTO CA 92583
RIVERSIDE county
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Practice Location

1221 STATE ST SUITE D
SAN JACINTO CA 92583
RIVERSIDE county
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Issuance Date

February 7, 2023

Expiration Date

October 31, 2026

Current Date / Time

June 7, 2025
3:13:3 AM

License Relationships

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: LEE, DAVID YOUNG HOON

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: NAMM, JUSTIN KIRK

Address Not Disclosed

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: ZAKLAMA, KARIM MAGID

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: 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: NAMM, JUSTIN KIRK

License/Registration Type: Dentist License

License Number: 102692 Primary Status: Current - Active

Address :
1221 N State St
Suite D
SAN JACINTO CA 92583-6322

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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, DAVID YOUNG HOON

License/Registration Type: Dentist License

License Number: 58617 Primary Status: Current - Active

Address :
1450 S Center St
REDLANDS CA 92373-7007
SAN BERNARDINO 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: ZAKLAMA, KARIM MAGID

License/Registration Type: Dentist License

License Number: 61349 Primary Status: Current - Active

Address :
2700 E Workman Ave
WEST COVINA CA 91791-6625
LOS ANGELES 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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