Provider Demographics
NPI:1710256235
Name:ADVANCED PAIN ASSOCIATES OF CALIFORNIA
Entity Type:Organization
Organization Name:ADVANCED PAIN ASSOCIATES OF CALIFORNIA
Other - Org Name:ADVANCED PAIN SOLUTIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-435-1757
Mailing Address - Street 1:6769 N FRESNO ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3715
Mailing Address - Country:US
Mailing Address - Phone:559-435-1757
Mailing Address - Fax:
Practice Address - Street 1:6169 N THESTA ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5266
Practice Address - Country:US
Practice Address - Phone:559-435-1757
Practice Address - Fax:559-435-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10743208VP0000X
CARHC16861208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADM762ZMedicare PIN