Healthcare Provider Details

I. General information

NPI: 1932786910
Provider Name (Legal Business Name): YELENA KABANSKAYA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 03/26/2021
Certification Date: 03/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 SAMARITAN DR
SAN JOSE CA
95124-3997
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 408-559-2011
  • Fax:
Mailing address:
  • Phone: 408-761-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: YELENA KABANSKAYA
Title or Position: PRESIDENT
Credential: MD
Phone: 408-761-3245