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Licensing details for: PTL 7481

Name: KIM, JEONG HWAN JAKE

License Type: Postgraduate Training License

Primary Status: License Canceled Primary Status Definition

School Name: University of Queensland Ochsner Clinical School

Graduation Year: 2020

Current Enrolled Postgraduate Training Program

Facility Name: HCA Healthcare/Los Robles Regional Medical Center Program

City: Thousand Oaks

State: California

Speciality: Internal medicine

Start Date: 07/01/2021

Anticipated End Date: 06/30/2024

Address of Record

2124 Lyans Dr
LA CANADA FLINTRIDGE CA 91011-1539
LOS ANGELES county
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Issuance Date

September 27, 2021

Expiration Date

N/A

Current Date / Time

April 3, 2026
2:03:06 AM

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License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Postgraduate Training License

Related Party Role: Physician & Surgeon

Name: KIM, JEONG HWAN JAKE

License/Registration Type: Physician's and Surgeon's

License Number: 194912 Primary Status: License Renewed & Current

Address :
215 W Janss Rd
THOUSAND OAKS CA 91360-1847
VENTURA COUNTY

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