Application Summary 3/26/19 11:26 AM License Type: License Number: File Number: Application: Application Number: Application Date: Dentist 51564 Change Status to Inactive 6822985 03/26/2019 (mm/dd/yyyy) Page 1 of 1 Personal Detail First Name: Last Name: KARYNA SHULIAK Addresses License Related Addresses Address of Record Warning: Confidential Address Warning: In order to protect your privacy and identity, address will not be displayed. In order to protect your privacy and identity, address will not be displayed. Attachments Attestation I certify under the penalty of perjury under the laws of the State of California that the foregoing and all attachments are true and correct. Signature: Date: 1553674801737 EFTA00524024