Healthcare Provider Details

I. General information

NPI: 1811190069
Provider Name (Legal Business Name): YU-CHI ANNIE WANG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 06/06/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 KAVANAUGH SUITE 1C
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

2119 BLACKBERRY LANE
CONWAY AR
72034
US

V. Phone/Fax

Practice location:
  • Phone: 501-291-0366
  • Fax: 501-214-5062
Mailing address:
  • Phone: 501-499-5824
  • Fax: 501-214-5062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberE6562
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE6562
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: