Provider Demographics
NPI:1063827673
Name:JI, EUNJUNG (DMD)
Entity type:Individual
Prefix:
First Name:EUNJUNG
Middle Name:
Last Name:JI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 N JOSEY LN STE 205
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-4679
Mailing Address - Country:US
Mailing Address - Phone:972-394-0912
Mailing Address - Fax:
Practice Address - Street 1:1265 CENTER RD
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14224-2313
Practice Address - Country:US
Practice Address - Phone:716-427-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2024-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD155581223G0001X
NY062927-011223G0001X
TX410291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice