| LCA CASE NUMBER | I-200-21264-597051 |
| STATUS | Certified |
| LCA CASE SUBMIT | 2021-09-21 |
| DECISION DATE | 2021-09-28 |
| VISA CLASS | H-1B |
| LCA CASE JOB TITLE | Dentist |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | True |
| LCA CASE EMPLOYMENT START DATE | 2021-10-18 |
| END DATE | 2024-10-17 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 0 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 1 |
| AMENDED PETITION | 0 |
| LCA CASE EMPLOYER NAME | Koushan Azad Dental Corporation |
| TRADE NAME DBA | CaliDental San Luis Obispo |
| EMPLOYER ADDRESS1 | 3870 Broad Street, Suite 1 |
| EMPLOYER CITY | San Luis Obispo |
| EMPLOYER STATE | CA |
| EMPLOYER POSTAL CODE | 93401 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PHONE | 18052024988 |
| NAICS CODE | 62121 |
| EMPLOYER POC LAST NAME | AZAD |
| EMPLOYER POC FIRST NAME | Koushan |
| EMPLOYER POC JOB TITLE | President & CEO |
| EMPLOYER POC ADDRESS1 | 3870 Broad Street, Suite 1 |
| EMPLOYER POC CITY | San Luis Obispo |
| EMPLOYER POC STATE | CA |
| EMPLOYER POC POSTAL CODE | 93401 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PHONE | 18052024988 |
| EMPLOYER POC EMAIL | [email protected] |
| AGENT REPRESENTING EMPLOYER | True |
| AGENT ATTORNEY LAST NAME | GOLD |
| AGENT ATTORNEY FIRST NAME | DANA |
| AGENT ATTORNEY MIDDLE NAME | ANN |
| AGENT ATTORNEY ADDRESS1 | 1630 N. MAIN STREET |
| AGENT ATTORNEY ADDRESS2 | SUITE 44 |
| AGENT ATTORNEY CITY | WALNUT CREEK |
| AGENT ATTORNEY STATE | CA |
| AGENT ATTORNEY POSTAL CODE | 94596 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PHONE | 19252320442 |
| AGENT ATTORNEY EMAIL ADDRESS | [email protected] |
| LAWFIRM NAME BUSINESS NAME | GOLD LAW OFFICES |
|
| STATE OF HIGHEST COURT | CA |
| NAME OF HIGHEST STATE COURT | SUPREME COURT |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | False |
| WORKSITE ADDRESS1 | 3870 Broad Street, Suite 1 |
| LCA CASE WORKLOC1 CITY | San Luis Obispo |
| WORKSITE COUNTY | SAN LUIS OBISPO |
| LCA CASE WORKLOC1 STATE | CA |
| WORKSITE POSTAL CODE | 93401 |
| LCA CASE WAGE RATE FROM | 100 |
| LCA CASE WAGE RATE UNIT | Hour |
| PREVAILING WAGE | 93.15 |
| PW UNIT OF PAY | Hour |
| PW WAGE LEVEL | III |
| PW OES YEAR | 7/1/2021 - 6/30/2022 |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | True |
| H-1B DEPENDENT | False |
| WILLFUL VIOLATOR | False |
| PUBLIC DISCLOSURE | Disclose Business |
| PREPARER LAST NAME | Schechter |
| PREPARER FIRST NAME | Niely |
| PREPARER BUSINESS NAME | Gold Law Offices |
| PREPARER EMAIL | [email protected] |
