Healthcare Provider Details

I. General information

NPI: 1922912757
Provider Name (Legal Business Name): KONA YANG CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 SANTA FE DR
ENCINITAS CA
92024-5142
US

IV. Provider business mailing address

5440 BALTIMORE DR UNIT 146
LA MESA CA
91942-2064
US

V. Phone/Fax

Practice location:
  • Phone: 760-633-6501
  • Fax:
Mailing address:
  • Phone: 619-764-1709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number852718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: