MEDICARE: DR. VADIM LEYENSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	522342	CA
2	207RP1001X	Pulmonary Disease Physician	MD184074	OR
3	207RS0012X	Sleep Medicine (Internal Medicine) Physician	1107	CA
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	MC-1352	ID
5	207RP1001X	Pulmonary Disease Physician	522342	CA
6	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	MD184074	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C154059	OTHER	CA	STATE MEDICAL LICENSE

General Provider Information

NPI Number	:	1427052851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VADIM LEYENSON MD

Provider Business Mailing Address
First Line	:	325 DISTEL CIR
Second Line	:
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1408
Country	:	US
Telephone Number	:	707-525-2902
Fax Number	:	707-525-2904

Provider Business Practice Location Address
First Line	:	95 MONTGOMERY DR STE 104
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-6617
Country	:	US
Telephone Number	:	707-525-2902
Fax Number	:	707-525-2904

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/14/2025

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Directions to “ DR. VADIM LEYENSON MD” Practice Location

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