Provider Demographics
NPI:1316096928
Name:KANDINOV, YELENA D (DDS)
Entity type:Individual
Prefix:DR
First Name:YELENA
Middle Name:D
Last Name:KANDINOV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 RIVERDALE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3642
Mailing Address - Country:US
Mailing Address - Phone:914-375-6735
Mailing Address - Fax:914-375-7456
Practice Address - Street 1:50 RIVERDALE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3642
Practice Address - Country:US
Practice Address - Phone:914-375-6735
Practice Address - Fax:914-375-7456
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0528301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02779133Medicaid