Healthcare Provider Details

I. General information

NPI: 1407164064
Provider Name (Legal Business Name): KAN-DI-KI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 YALE BLVD SE STE 201
ALBUQUERQUE NM
87106-4200
US

IV. Provider business mailing address

2820 N ONTARIO ST
BURBANK CA
91504-2015
US

V. Phone/Fax

Practice location:
  • Phone: 505-508-2569
  • Fax: 505-508-2715
Mailing address:
  • Phone: 818-549-1880
  • Fax: 818-333-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID VELEZ
Title or Position: EXECUTIVE VP
Credential:
Phone: 800-940-0389