Provider Demographics
NPI:1639186406
Name:WANG, DAI-YUAN (MD)
Entity Type:Individual
Prefix:
First Name:DAI-YUAN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2759
Mailing Address - Country:US
Mailing Address - Phone:479-968-4311
Mailing Address - Fax:479-968-4399
Practice Address - Street 1:2205 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-2759
Practice Address - Country:US
Practice Address - Phone:479-968-4311
Practice Address - Fax:479-968-4399
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112423207RC0000X
NY207229207RC0000X
ARE-5291207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00204251OtherRAILROAD MEDICARE
AR166953001Medicaid
IL036112423Medicaid
AR166953001Medicaid
AR5H030Medicare PIN
IL036112423Medicaid