MINTAE KIM Dentist License verification

Business Entity

NOT RENEWED

License Type

Dentist

Description

LICENSED DENTIST CONTROLLED SUBSTANCE

License Number

31*****82

License Status

NOT RENEWED

Business

First Name

MINTAE

Last Name

KIM

Business Name

MINTAE KIM

Original Issue Date

08/07/2017

Effective Date

02/25/2022

Expiration Date

09/30/2024

City

CHICAGO

State

Zip

60622

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

02/04/2025