Provider Demographics
NPI:1235372582
Name:KOGAN, YELENA
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:KOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 KEHRS MILL RD
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2402
Mailing Address - Country:US
Mailing Address - Phone:636-256-6666
Mailing Address - Fax:636-391-0010
Practice Address - Street 1:920 KEHRS MILL RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2402
Practice Address - Country:US
Practice Address - Phone:636-256-6666
Practice Address - Fax:636-391-0010
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7F83208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics