Individual provider Active NPI

Desiree Lorraine Yllan, DC

  • Sports Physician Chiropractor
  • Redondo Beach, CA
National Provider Identifier
1811563802
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
33618 Issued in CA
Practice address
234 S Pacific Coast Hwy Ste 205
Redondo Beach, CA 90277-7036
Phone
(424) 262-3107
NPI assigned
Jun 1, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 34618 CA
Radiology Chiropractor 111NR0200X 00207166 CA
Rehabilitation Chiropractor 111NR0400X 34618 CA
Sports Physician Chiropractor 111NS0005X 33618 CA Primary

Addresses

Primary practice location

234 S Pacific Coast Hwy Ste 205
Redondo Beach, CA 90277-7036

Mailing address

1821 Belmont LN Apt a
Redondo Beach, CA 90278-4154
Phone (408) 429-9793

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220228000939 CA Practitioner - Chiropractic 5092109512 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34618CAMDMental Health Counselor
00207166CAMDRadiology Chiropractor
33618CAMDSports Physician Chiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
100 Chiropractic Helfrich SJ Inc Chiropractor CurrentSince Sep 24, 2023 Accepting new patients
Mati Custom Chiropractic Corporation Chiropractor PastSince Jan 6, 2022 Accepting new patients
Dana Laridaen Chiropractic Inc. Chiropractor PastSince Jun 1, 2024 Accepting new patients

Locations

1411 Berryessa Rd
Ste 40
San Jose, CA 95133
Phone (669) 263-6971

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744848000000",
    "number": "1811563802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 BELMONT LN APT A",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902784154",
            "telephone_number": "408-429-9793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 S PACIFIC COAST HWY STE 205",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902777036",
            "telephone_number": "424-262-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YLLAN",
        "first_name": "DESIREE",
        "middle_name": "LORRAINE",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-01",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "34618",
            "primary": false
        },
        {
            "code": "111NR0200X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Radiology",
            "state": "CA",
            "license": "00207166",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "CA",
            "license": "34618",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "CA",
            "license": "33618",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redondo Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.