Provider Demographics
NPI:1134648694
Name:ADVANCED PAIN DIAGNOSTIC & SOLUTIONS, INC.
Entity Type:Organization
Organization Name:ADVANCED PAIN DIAGNOSTIC & SOLUTIONS, INC.
Other - Org Name:KAYVAN D. HADDADAN, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT & CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:KAYVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDADAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-786-6192
Mailing Address - Street 1:729 SUNRISE AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4542
Mailing Address - Country:US
Mailing Address - Phone:916-953-7571
Mailing Address - Fax:916-771-8515
Practice Address - Street 1:2160 SUNSET BLVD STE 502
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-4790
Practice Address - Country:US
Practice Address - Phone:916-953-7571
Practice Address - Fax:916-771-8515
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED PAIN DIAGNOSTIC & SOLUTIONS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-15
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP3300X
CAC507192086S0122X
CAA87957208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty