Provider Demographics
NPI:1811563802
Name:YLLAN, DESIREE LORRAINE (DC)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:LORRAINE
Last Name:YLLAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-4953
Mailing Address - Country:US
Mailing Address - Phone:408-429-9793
Mailing Address - Fax:
Practice Address - Street 1:1411 BERRYESSA RD UNIT 40
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95133-1014
Practice Address - Country:US
Practice Address - Phone:669-263-6971
Practice Address - Fax:669-263-6955
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34618111NR0400X, 111N00000X
CA33618111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
No111NS0005XChiropractic ProvidersChiropractorSports Physician