Provider Demographics
NPI:1083934830
Name:AUSTIN FERTILITY INSTITUTE, PA
Entity Type:Organization
Organization Name:AUSTIN FERTILITY INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:KAMYAR
Authorized Official - Last Name:MOGHADAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-339-4234
Mailing Address - Street 1:2200 PARK BEND DR
Mailing Address - Street 2:BLDG. 2 - SUITE 204
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5387
Mailing Address - Country:US
Mailing Address - Phone:512-339-4234
Mailing Address - Fax:512-339-4237
Practice Address - Street 1:2200 PARK BEND DR
Practice Address - Street 2:BLDG. 2 - SUITE 204
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5387
Practice Address - Country:US
Practice Address - Phone:512-339-4234
Practice Address - Fax:512-339-4237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5874207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty