GOTH KWO FUNG SIU DMD Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****08

License Status

NOT RENEWED

Business

Title

DMD

First Name

GOTH

Middle

KWO FUNG

Last Name

SIU

Business Name

GOTH KWO FUNG SIU DMD

Original Issue Date

07/19/2011

Effective Date

07/19/2011

Expiration Date

09/30/2012

City

CHICAGO

State

Zip

60612

County

COOK

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/14/2012