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General NPI Number Information
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NPI Number | 1184822231
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Entity Type | Individual
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Provider Name | JERRY CHUNG M.D
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Gender | Male
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 200 W ARBOR DR
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City | SAN DIEGO
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State | CA
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Zip | 92103-9001
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Country | US
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Telephone | 619-543-1849
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Fax |
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Provider Business Mailing Address
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Address Line | 5230 FIORE TER APT # 408
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City | SAN DIEGO
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State | CA
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Zip | 92122-5648
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Country | US
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Telephone | 917-597-9740
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | A98189
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME101742
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License Number State | FL
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