Healthcare Provider Details

I. General information

NPI: 1043972052
Provider Name (Legal Business Name): KEITA SEKINE OMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 S MARYLAND PKWY
LAS VEGAS NV
89104-1736
US

IV. Provider business mailing address

1223 S MARYLAND PKWY
LAS VEGAS NV
89104-1736
US

V. Phone/Fax

Practice location:
  • Phone: 702-241-9577
  • Fax:
Mailing address:
  • Phone: 702-241-9577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2036
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: