Dental Board of California
Licensing details for: 4870
Name: HEALTHY SMILE FAMILY DENTISTRY, DENTAL OFFICE OF
License Type: Fictitious Name Permit
Primary Status: Current - Active
Organization Classification: Corporation
Address of Record
1315 FAIR OAKS AVE, STE 103
SOUTH PASADENA CA 91030
LOS ANGELES county
Map
License Relationships
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: CHAN, KENNETH
Address Not Disclosed
FNP Owners
License/Registration Role: Fictitious Name Permit
Related Party Role: Owners
Name: CHAN, KENNETH KA-TAT
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: CHAN, KENNETH KA-TAT
License/Registration Type: Dentist License
License Number: 47857 Primary Status: Current - Active
Address :
1315 Fair Oaks Ave
103
SOUTH PASADENA CA 91030
