Healthcare Provider Details

I. General information

NPI: 1396653549
Provider Name (Legal Business Name): KAYLA YEELES
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: KAYLA LIM

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 AVENUE ALHAMBRA STE 5
EL GRANADA CA
94018-8133
US

IV. Provider business mailing address

PO BOX 917
MOSS BEACH CA
94038-0917
US

V. Phone/Fax

Practice location:
  • Phone: 650-560-9470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number36062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: