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General NPI Number Information
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NPI Number | 1407080245
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Entity Type | Individual
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Provider Name | JONATHAN CHAE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 3600 W BETHEL AVE
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City | MUNCIE
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State | IN
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Zip | 47304-5407
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Country | US
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Telephone | 765-284-7738
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Fax | 765-213-3713
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Provider Business Mailing Address
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Address Line | 3600 W BETHEL AVE
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City | MUNCIE
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State | IN
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Zip | 47304-5407
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Country | US
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Telephone | 800-622-6575
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | R2217
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 35.129960
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 01075645A
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License Number State | IN
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