Healthcare Provider Details

I. General information

NPI: 1114806270
Provider Name (Legal Business Name): KHRIZNA CHONG MSN, RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 09/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR
SAN DIEGO CA
92121-3021
US

IV. Provider business mailing address

9416 HITO CT
SAN DIEGO CA
92129-4914
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-7729
  • Fax:
Mailing address:
  • Phone: 858-335-0524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number3024
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: