Individual
JERRY BAULOONG HUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(918) 784-1535
Mailing address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(918) 784-1535
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
2010-01969
NC
207RP1001X
Pulmonary Disease Physician
ME98151
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18636
BLUE CROSS BLUE SHIELD
FL
01
—
2010-01969
MEDICAL LICENSE
NC
01
—
229139
STATE MEDICAL LICENSE
NY
05
—
279560400
—
FL
01
—
P00434938
RR MEDICARE
FL
Enumeration date
12/19/2006
Last updated
09/28/2023
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