Basic Information
| Provider Information | |||||||||
| NPI: | 1932786910 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YELENA KABANSKAYA MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6081 MERIDIAN AVE STE 70 | ||||||||
| Address2: | #155 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951202752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087613245 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2425 SAMARITAN DR | ||||||||
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| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951243997 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4085592011 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2021 | ||||||||
| LastUpdateDate: | 03/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | KABANSKAYA | ||||||||
| AuthorizedOfficialFirstName: | YELENA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4087613245 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
No ID Information.