MEDICARE: KELHEALTHANDWELLNESS MED CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1659163970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELHEALTHANDWELLNESS MED CORP

Provider Business Mailing Address
First Line	:	1225 CYPRESS AVE APT 3
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1173
Country	:	US
Telephone Number	:	206-456-6933
Fax Number	:

Provider Business Practice Location Address
First Line	:	1225 CYPRESS AVE STE 3
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-1112
Country	:	US
Telephone Number	:	626-768-2649
Fax Number	:	626-995-1540

Authorized Official
Title or Position	:	CEO
Name	:	KELECHI OKWARAJI
Credential	:
Telephone Number	:	206-456-6933

Provider Enumeration Date	:	05/21/2025
Last Update Date	:	02/25/2026

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