Healthcare Provider Details

I. General information

NPI: 1558162289
Provider Name (Legal Business Name): KANDI DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 DEMPSTER ST STE 502
PARK RIDGE IL
60068-8429
US

IV. Provider business mailing address

2604 DEMPSTER ST STE 502
PARK RIDGE IL
60068-8429
US

V. Phone/Fax

Practice location:
  • Phone: 224-217-5400
  • Fax: 224-217-5405
Mailing address:
  • Phone: 224-217-5400
  • Fax: 224-217-5405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAVEH KANDI
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 224-217-5400