Healthcare Provider Details

I. General information

NPI: 1538127832
Provider Name (Legal Business Name): KAYVAN D HADDADAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HOWE AVE STE 600
SACRAMENTO CA
95825-4797
US

IV. Provider business mailing address

729 SUNRISE AVE STE 611
ROSEVILLE CA
95661-4548
US

V. Phone/Fax

Practice location:
  • Phone: 916-953-7571
  • Fax: 916-771-8515
Mailing address:
  • Phone: 916-953-7571
  • Fax: 916-771-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA87957
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA87957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: