MEDICARE: DR. DESIREE LORRAINE YLLAN DC

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	111N00000X	Chiropractor	34618	CA
2	111NR0200X	Radiology Chiropractor	00207166	CA
3	111NR0400X	Rehabilitation Chiropractor	34618	CA
4	111NS0005X	Sports Physician Chiropractor	33618	CA

General Provider Information

NPI Number	:	1811563802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DESIREE LORRAINE YLLAN DC

Provider Business Mailing Address
First Line	:	1821 BELMONT LN APT A
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-4154
Country	:	US
Telephone Number	:	408-429-9793
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 S PACIFIC COAST HWY STE 205
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-7036
Country	:	US
Telephone Number	:	424-262-3107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	04/17/2025

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