Kamran Pakdamanian, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

108876 Issued in CA

Practice address

460 N McKinley St Ste 101
Corona, CA 92879-3405

Phone

(951) 531-9693

NPI assigned

Apr 24, 2023

Last updated

Sep 1, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Trevor Thomas Dental Corporation

  dba Corona Modern Dentistry Dental Group

  • General Practice Dentistry
  • Corona, CA
  • NPI 1639731888
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693526400000",
    "number": "1255028767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 SAGELEAF CIR",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928822318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 N MCKINLEY ST STE 101",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793405",
            "telephone_number": "951-531-9693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAKDAMANIAN",
        "first_name": "KAMRAN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-24",
        "last_updated": "2023-09-01",
        "certification_date": "2023-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "108876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Paik, D.C.
• Bryan Paine
• Jewell Angelique Painter
• Cristina Gonzales Pajarillaga-Encello, NP-BC
• Patrick Pak, PA
• Kayvon Pakdamanian, PA
• Jayanta Kumar Pal, MD
• Vianey Palacios Maya
• Brenda L Palacios, M.S.
• Juan Carlos Palacios

• Dentist in Corona, CA
• Providers in Corona, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.