Basic Information
| Provider Information | |||||||||
| NPI: | 1376179374 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YUEN | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | DERECHO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 653 ARBOLEDA DR | ||||||||
| Address2: | |||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940244115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6504859244 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2250 ALCAZAR ST # 2200 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900891011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234426000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2020 | ||||||||
| LastUpdateDate: | 03/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.