Individual
JAE CHUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
22395 EDGEWATER DR, PORT CHARLOTTE, FL 33980-2012
(941) 766-7222
(941) 766-0970
Mailing address
PO BOX 102222, ATLANTA, GA 30368-2222
(239) 274-8200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
ME150694
FL
207RX0202X
Medical Oncology Physician
Primary
ME150694
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111271700
—
FL
Enumeration date
04/13/2015
Last updated
02/09/2026
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