JI S KIM DDS Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****64

License Status

NOT RENEWED

Business

First Name

Middle

Last Name

KIM

Suffix

DDS

Business Name

JI S KIM DDS

Original Issue Date

12/22/2003

Effective Date

12/22/2003

Expiration Date

09/30/2006

City

PEORIA

State

Zip

61614

County

PEORIA

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

11/08/2006