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General NPI Number Information
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NPI Number | 1639186406
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Entity Type | Individual
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Provider Name | DAI-YUAN WANG MD
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Gender | Male
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 2205 W MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2759
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Country | US
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Telephone | 479-968-4311
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Fax | 479-968-4399
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Provider Business Mailing Address
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Address Line | 2205 W MAIN ST
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City | RUSSELLVILLE
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State | AR
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Zip | 72801-2759
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Country | US
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Telephone | 479-968-4311
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Fax | 479-968-4399
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036112423
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 207229
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | E-5291
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License Number State | AR
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