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General NPI Number Information
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NPI Number | 1316203235
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Entity Type | Individual
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Provider Name | CAROLYN HAYES WONG MD
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Gender | Female
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Dates
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Enumeration Date | 04/04/2012
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 2200 E SHOW LOW LAKE RD
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City | SHOW LOW
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State | AZ
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Zip | 85901-7831
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Country | US
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Telephone | 928-537-4375
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Fax |
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Provider Business Mailing Address
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Address Line | 800 BRADBURY DR SE STE 116
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City | ALBUQUERQUE
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State | NM
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Zip | 87106-4310
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Country | US
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Telephone |
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Fax |
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD2025-0565
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 76771
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License Number State | AZ
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