Healthcare Provider Details

I. General information

NPI: 1205287364
Provider Name (Legal Business Name): WESTERN FERTILITY INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 06/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD 210
ENCINO CA
91436-2203
US

IV. Provider business mailing address

16260 VENTURA BLVD 210
ENCINO CA
91436-2203
US

V. Phone/Fax

Practice location:
  • Phone: 818-292-2242
  • Fax:
Mailing address:
  • Phone: 818-292-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA80341
License Number StateCA

VIII. Authorized Official

Name: ASHIM KUMAR
Title or Position: MANAGER
Credential: M.D.
Phone: 818-292-2242