Healthcare Provider Details

I. General information

NPI: 1669977542
Provider Name (Legal Business Name): KATERINA LYNN YALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2018
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

118 MED SURGE 1 DEPT OF DERMATOLOGY
IRVINE CA
92697-0001
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-0606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA165234
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA165234
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA165234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: