MEDICARE: JAE W 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	174400000X	Specialist	25MA07546600	NJ
2	207L00000X	Anesthesiology Physician	2348/23	NY

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	:	1629071840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE W CHUNG M.D.

Provider Business Mailing Address
First Line	:	1 GUTHRIE DR
Second Line	:
City	:	CORNING
State	:	NY
Zip	:	14830-3696
Country	:	US
Telephone Number	:	607-973-7200
Fax Number	:	607-937-7866

Provider Business Practice Location Address
First Line	:	1 GUTHRIE DR
Second Line	:
City	:	CORNING
State	:	NY
Zip	:	14830-3696
Country	:	US
Telephone Number	:	607-973-7200
Fax Number	:	607-937-7866

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	01/27/2017

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