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Licensing details for: 9338

Name: MIRACLE SMILE DENTAL PRACTICE OF K. HYOSONG BAE DDS, A PROFESSION

License Type: Fictitious Name Permit

Primary Status: Current - Active

Organization Classification: Corporation

Previous Names: MIRACLE SMILE DENTISTRY

Address of Record

2005-B3E PARK PLACE
EL SEGUNDO CA 90245
LOS ANGELES county
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Practice Location

2005-B3E PARK PLACE
EL SEGUNDO CA 90245
LOS ANGELES county
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Issuance Date

May 24, 2011

Expiration Date

February 28, 2027

Current Date / Time

June 6, 2025
10:16:50 AM

License Relationships

FNP Owners

License/Registration Role: Fictitious Name Permit

Related Party Role: Owners

Name: BAE, KRISTY HYOSONG

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: BAE, KRISTY HYOSONG

License/Registration Type: Dentist License

License Number: 43110 Primary Status: Current - Active

Address :
2005 B3E Park Place
EL SEGUNDO CA 90245

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