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General NPI Number Information
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NPI Number | 1073908604
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Entity Type | Organization
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Legal Business Name | ADVANCED SURGICAL GROUP, INC.
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Dates
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Enumeration Date | 03/31/2015
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 2160 SUNSET BLVD SUITE 502
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City | ROCKLIN
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State | CA
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Zip | 95765-4790
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Country | US
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Telephone | 916-258-7250
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Fax | 916-787-5401
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Provider Business Mailing Address
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Address Line | 2160 SUNSET BLVD STE 502
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City | ROCKLIN
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State | CA
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Zip | 95765-4790
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Country | US
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Telephone | 916-258-7250
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Fax | 916-787-5401
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Authorized Official
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Title or Position | PRESIDENT & CHARIMAN
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Name | KAYVAN D HADDADAN
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Credential | MD
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Telephone | 415-786-6192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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