Healthcare Provider Details

I. General information

NPI: 1851233985
Provider Name (Legal Business Name): SOHYUN KELSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6655 W SAHARA AVE STE A206
LAS VEGAS NV
89146-2812
US

IV. Provider business mailing address

PO BOX 400637
LAS VEGAS NV
89140-0637
US

V. Phone/Fax

Practice location:
  • Phone: 702-202-3383
  • Fax:
Mailing address:
  • Phone: 702-900-8689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: