Healthcare Provider Details

I. General information

NPI: 1265338172
Provider Name (Legal Business Name): KEONI JEFFREY CHOCK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2026
Last Update Date: 10/16/2026
Certification Date: 10/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE FL 5
LONG BEACH CA
90806-2325
US

IV. Provider business mailing address

9672 DAYBREAK DR
HUNTINGTON BEACH CA
92646-7527
US

V. Phone/Fax

Practice location:
  • Phone: 844-562-1212
  • Fax:
Mailing address:
  • Phone: 909-222-2897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number95448945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: