MEDICARE: DR. JERRY CHUNG M.D

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	2085R0204X	Vascular & Interventional Radiology Physician	A98189	CA
2	2085R0202X	Diagnostic Radiology Physician	ME101742	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184822231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERRY CHUNG M.D

Provider Business Mailing Address
First Line	:	5230 FIORE TER
Second Line	:	APT # 408
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5648
Country	:	US
Telephone Number	:	917-597-9740
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W ARBOR DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	619-543-1849
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	12/29/2025

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Directions to “ DR. JERRY CHUNG M.D” Practice Location

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