Provider Demographics
NPI:1487738696
Name:KOSS, YELENA (MD)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:KOSS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 BOVET RD FL 6
Mailing Address - Street 2:C/O CD BILLING
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-3116
Mailing Address - Country:US
Mailing Address - Phone:701-255-9279
Mailing Address - Fax:701-222-4142
Practice Address - Street 1:1838 EL CAMINO REAL STE 100
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3105
Practice Address - Country:US
Practice Address - Phone:650-347-1182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA535852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG59948Medicare UPIN
CA00A535850Medicare ID - Type Unspecified