Provider Demographics
NPI:1174840565
Name:TAHERI, KEVIN (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:TAHERI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1401 MEDICAL PKWY STE 407
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-5015
Mailing Address - Country:US
Mailing Address - Phone:512-879-1461
Mailing Address - Fax:512-879-1462
Practice Address - Street 1:720 W 34TH ST STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1202
Practice Address - Country:US
Practice Address - Phone:512-346-7600
Practice Address - Fax:512-346-7603
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2022-02-17
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Provider Licenses
StateLicense IDTaxonomies
TXQ5106207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ5106OtherTEXAS STATE LICENSE