Individual provider Active NPI

Bryan Wong, AUD

  • Audiologist-Hearing Aid Fitter
  • Tucson, AZ
National Provider Identifier
1154147213
Registry record updated Nov 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Audiologist-Hearing Aid FitterTaxonomy code 237600000X
License
DA12262 Issued in AZ
Practice address
1131 E 2ND St
Tucson, AZ 85721-0001
Phone
(520) 621-7070
NPI assigned
Nov 22, 2024
Last updated
Nov 22, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist-Hearing Aid Fitter 237600000X DA12262 AZ Primary

Addresses

Primary practice location

1131 E 2ND St
Tucson, AZ 85721-0001

Mailing address

1131 E 2ND St
Tucson, AZ 85721-0001
Phone (520) 621-7070

Other practice location 1

350 N Wilmot Rd
Tucson, AZ 85711-2602
Phone (520) 873-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250129003224 AZ Practitioner - Qualified Audiologist 0143759597 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DA12262AZMDAudiologist-Hearing Aid Fitter

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Clinics for Rehabilitative Services CurrentSince Jan 13, 2025 Accepting new patients

Locations

2600 N Wyatt Dr
Tucson, AZ 85712
Phone (520) 324-3600

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732233600000",
    "number": "1154147213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1131 E 2ND ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857210001",
            "telephone_number": "520-621-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1131 E 2ND ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857210001",
            "telephone_number": "520-621-7070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "350 N Wilmot Rd",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857112602",
            "country_code": "US",
            "telephone_number": "520-873-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WONG",
        "first_name": "BRYAN",
        "credential": "AUD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-22",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "AZ",
            "license": "DA12262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.