Healthcare Provider Details

I. General information

NPI: 1245185297
Provider Name (Legal Business Name): EOON HYE JI DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 VETERAN AVE APT 307
LOS ANGELES CA
90024-8002
US

IV. Provider business mailing address

530 VETERAN AVE APT 307
LOS ANGELES CA
90024-8002
US

V. Phone/Fax

Practice location:
  • Phone: 213-210-9134
  • Fax:
Mailing address:
  • Phone: 213-210-9134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. EOON HYE GRACE JI
Title or Position: DOCTOR
Credential: DDS. PHD. MS. MICOI
Phone: 213-210-9134