MEDICARE: EOON HYE JI DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1245185297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EOON HYE JI DDS INC

Provider Business Mailing Address
First Line	:	530 VETERAN AVE APT 307
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-8002
Country	:	US
Telephone Number	:	213-210-9134
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 VETERAN AVE APT 307
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-8002
Country	:	US
Telephone Number	:	213-210-9134
Fax Number	:

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

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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Directions to “EOON HYE JI DDS INC ” Practice Location

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