Healthcare Provider Details

I. General information

NPI: 1891006714
Provider Name (Legal Business Name): YELENA KABANSKAYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 SAMARITAN DR
SAN JOSE CA
95124-3908
US

IV. Provider business mailing address

6081 MERIDIAN AVE SUITE 70 #155
SAN JOSE CA
95120-2752
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-2011
  • Fax:
Mailing address:
  • Phone: 408-317-1451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA112330
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA112330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: