Provider Demographics
NPI:1790780294
Name:LUNG, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:LUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CORAL WAY
Mailing Address - Street 2:SUITE 408
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4930
Mailing Address - Country:US
Mailing Address - Phone:305-446-7376
Mailing Address - Fax:305-446-1665
Practice Address - Street 1:401 CORAL WAY
Practice Address - Street 2:SUITE 408
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4930
Practice Address - Country:US
Practice Address - Phone:305-446-7376
Practice Address - Fax:305-446-1665
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074477174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3421Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
FLC29141Medicare UPIN