Healthcare Provider Details

I. General information

NPI: 1154958171
Provider Name (Legal Business Name): RUI WANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1961 NORTHPOINT BLVD STE 110
HIXSON TN
37343-4556
US

IV. Provider business mailing address

9050 EXECUTIVE PARK DR STE 202A
KNOXVILLE TN
37923-4670
US

V. Phone/Fax

Practice location:
  • Phone: 423-756-1002
  • Fax:
Mailing address:
  • Phone: 865-588-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number75789
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number2024007822
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number75789
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: