Provider Demographics
NPI:1104841360
Name:CHUNG, EDWIN KYUNG (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:KYUNG
Last Name:CHUNG
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:2343 AARON ST
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5305
Practice Address - Country:US
Practice Address - Phone:855-979-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124752207R00000X, 207RH0005X, 207RN0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension SpecialistGroup - Single Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010043539CT01OtherANTHEM BC/BS
CT158AL2OtherEMPIRE BC/BS
CT5946289OtherCIGNA
CT043539OtherCONNECTICARE
CTP00258635OtherRAILROAD MEDICARE
CT2V6419OtherHEALTH NET
CT3990495OtherAETNA HMO
CT7169750OtherAETNA - PPO
CTP3629181OtherOXFORD HEALTH PLANS
CT158AL2OtherEMPIRE BC/BS
CT5946289OtherCIGNA