Provider Demographics
NPI:1427322635
Name:ADVANCED PAIN DIAGNOSTIC & SOLUTIONS, INC.
Entity type:Organization
Organization Name:ADVANCED PAIN DIAGNOSTIC & SOLUTIONS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYVAN
Authorized Official - Middle Name:DON
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 1:729 SUNRISE AVE STE 602
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4542
Practice Address - Country:US
Practice Address - Phone:916-953-7571
Practice Address - Fax:916-771-8515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
POO745259OtherMEDICARE RAILROAD
CA00A879570OtherMEDICARE ID TYPE UNSPECIFIED
CA00A879570OtherMEDICARE ID TYPE UNSPECIFIED
L18886Medicare UPIN
POO745259OtherMEDICARE RAILROAD