| CASE NUMBER | I-200-24339-517683 |
| CASE STATUS | Certified |
| RECEIVED DATE | 12/4/2024 |
| DECISION DATE | 12/11/2024 |
| ORIGINAL CERT DATE | |
| VISA CLASS | H-1B |
| JOB TITLE | GENERAL DENTIST |
| SOC CODE | 29-1021.00 |
| SOC TITLE | Dentists, General |
| FULL TIME POSITION | Y |
| BEGIN DATE | 1/1/2025 |
| END DATE | 12/31/2027 |
| TOTAL WORKER POSITIONS | 1 |
| NEW EMPLOYMENT | 1 |
| CONTINUED EMPLOYMENT | 0 |
| CHANGE PREVIOUS EMPLOYMENT | 0 |
| NEW CONCURRENT EMPLOYMENT | 0 |
| CHANGE EMPLOYER | 0 |
| AMENDED PETITION | 0 |
| EMPLOYER NAME | Jyothsna Reddy Sabalam, DMD, Inc. |
| TRADE NAME DBA | |
| EMPLOYER ADDRESS1 | 2416 Professional Dr. |
| EMPLOYER ADDRESS2 | |
| EMPLOYER CITY | Roseville |
| EMPLOYER STATE | CA |
| EMPLOYER POSTAL CODE | 95661 |
| EMPLOYER COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER PROVINCE | |
| EMPLOYER PHONE | 19167733567 |
| EMPLOYER PHONE EXT | |
| NAICS CODE | 621210 |
| EMPLOYER POC LAST NAME | Lee |
| EMPLOYER POC FIRST NAME | Steven |
| EMPLOYER POC MIDDLE NAME | F. |
| EMPLOYER POC JOB TITLE | Board Member |
| EMPLOYER POC ADDRESS1 | 2416 Professional Dr. |
| EMPLOYER POC ADDRESS2 | |
| EMPLOYER POC CITY | Roseville |
| EMPLOYER POC STATE | CA |
| EMPLOYER POC POSTAL CODE | 95661 |
| EMPLOYER POC COUNTRY | UNITED STATES OF AMERICA |
| EMPLOYER POC PROVINCE | |
| EMPLOYER POC PHONE | 19167733567 |
| EMPLOYER POC PHONE EXT | |
| EMPLOYER POC EMAIL | tigerucla@juno.com |
| AGENT REPRESENTING EMPLOYER | Yes |
| AGENT ATTORNEY LAST NAME | Nguyen |
| AGENT ATTORNEY FIRST NAME | Khoa |
| AGENT ATTORNEY MIDDLE NAME | Dang |
| AGENT ATTORNEY ADDRESS1 | 6100 Corporate Dr |
| AGENT ATTORNEY ADDRESS2 | STE 170 |
| AGENT ATTORNEY CITY | Houston |
| AGENT ATTORNEY STATE | TX |
| AGENT ATTORNEY POSTAL CODE | 77036 |
| AGENT ATTORNEY COUNTRY | UNITED STATES OF AMERICA |
| AGENT ATTORNEY PROVINCE | |
| AGENT ATTORNEY PHONE | 12812243835 |
| AGENT ATTORNEY PHONE EXT | |
| AGENT ATTORNEY EMAIL ADDRESS | steven@sknlawfirm.com |
| LAWFIRM NAME BUSINESS NAME | Law Office of Steven Nguyen |
| STATE OF HIGHEST COURT | TX |
| NAME OF HIGHEST STATE COURT | Supreme Court |
| WORKSITE WORKERS | 1 |
| SECONDARY ENTITY | No |
| SECONDARY ENTITY BUSINESS NAME | |
| WORKSITE ADDRESS1 | 2416 Professional Dr. |
| WORKSITE ADDRESS2 | |
| WORKSITE CITY | Roseville |
| WORKSITE COUNTY | PLACER |
| WORKSITE STATE | CA |
| WORKSITE POSTAL CODE | 95661 |
| WAGE RATE OF PAY FROM | $120,000.00 |
| WAGE RATE OF PAY FROM CLEANED | |
| WAGE RATE OF PAY TO | |
| WAGE UNIT OF PAY | Year |
| PREVAILING WAGE | $105,394.00 |
| PW UNIT OF PAY | Year |
| PW TRACKING NUMBER | |
| PW WAGE LEVEL | I |
| PW OES YEAR | 7/1/2024 - 6/30/2025 |
| PW OTHER SOURCE | |
| PW OTHER YEAR | |
| PW SURVEY PUBLISHER | |
| PW SURVEY NAME | |
| TOTAL WORKSITE LOCATIONS | 1 |
| AGREE TO LC STATEMENT | Yes |
| H 1B DEPENDENT | No |
| WILLFUL VIOLATOR | No |
| SUPPORT H1B | N/A |
| STATUTORY BASIS | |
| APPENDIX A ATTACHED | N/A |
| PUBLIC DISCLOSURE | Disclose Business and Employment |
| PREPARER LAST NAME | |
| PREPARER FIRST NAME | |
| PREPARER MIDDLE INITIAL | |
| PREPARER BUSINESS NAME | |
| PREPARER EMAIL | |
| BEGIN DATE CONVERTED | 2025-01-01 |
