KI C KIM DDS Dentist License verification

Business Entity

ACTIVE

License Type

Dentist

Description

TEMPORARY DENTAL TRAINING LICENSE

License Number

018001505

License Status

ACTIVE

Business

First Name

Middle

Last Name

KIM

Suffix

DDS

Business Name

KI C KIM DDS

Original Issue Date

09/29/2004

Effective Date

09/29/2004

Expiration Date

01/31/3004

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

Prosthodontics

Ever Disciplined

LastModifiedDate

10/12/2005