Active NPI
Tyler Wong
- Dentist
- Phoenix, AZ
National Provider Identifier
1396538773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D012499
- Practice address
- 35004 N North Valley Pkwy
Phoenix, AZ 85086-3254 - Phone
- (623) 879-9503
- NPI assigned
- May 27, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D012499 | AZ | Primary |
Addresses
Primary practice location
35004 N North Valley Pkwy
Phoenix, AZ 85086-3254
Mailing address
35004 N North Valley Pkwy Ste 110
Phoenix, AZ 85086-3255
Phone (623) 879-9503
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251014004493 | AZ | Order and Referring Only - Dentist | 0840787784 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D012499 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1748304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749427200000",
"number": "1396538773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "35004 N NORTH VALLEY PKWY STE 110",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850863255",
"telephone_number": "623-879-9503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35004 N NORTH VALLEY PKWY",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850863254",
"telephone_number": "623-879-9503"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "TYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-05-27",
"last_updated": "2025-06-09",
"certification_date": "2025-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "D012499",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.