Healthcare Provider Details

I. General information

NPI: 1720914989
Provider Name (Legal Business Name): KELLY WOLSCHON RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 VOORHEES AVE
REDONDO BEACH CA
90278-2423
US

IV. Provider business mailing address

2211 VOORHEES AVE
REDONDO BEACH CA
90278-2423
US

V. Phone/Fax

Practice location:
  • Phone: 310-947-9182
  • Fax:
Mailing address:
  • Phone:
  • Fax: 310-947-9182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number805831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: