Healthcare Provider Details

I. General information

NPI: 1548422488
Provider Name (Legal Business Name): KAN-DI-KI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12612 RAYMER ST
NORTH HOLLYWOOD CA
91605-4307
US

IV. Provider business mailing address

930 RIDGEBROOK RD FL 3
SPARKS GLENCO MD
21152-9481
US

V. Phone/Fax

Practice location:
  • Phone: 818-549-1880
  • Fax:
Mailing address:
  • Phone: 800-786-8015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN C CUOMO
Title or Position: AUTHORIZED OFFICIAL/CFO
Credential:
Phone: 7-868-0158