Healthcare Provider Details

I. General information

NPI: 1982812483
Provider Name (Legal Business Name): SHYAM MOHAN DANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST UAMS BOX# 567
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

875 OAK ST SE
SALEM OR
97301-3975
US

V. Phone/Fax

Practice location:
  • Phone: 501-686-5162
  • Fax:
Mailing address:
  • Phone: 503-399-7520
  • Fax: 503-362-7344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD197953
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberE-7120
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD60858449
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: