Healthcare Provider Details

I. General information

NPI: 1700198330
Provider Name (Legal Business Name): KAN-DI-KI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7355 PRAIRIE FALCON RD
LAS VEGAS NV
89128-0801
US

IV. Provider business mailing address

930 RIDGEBROOK RD
SPARKS MD
21152-9481
US

V. Phone/Fax

Practice location:
  • Phone: 702-589-9795
  • Fax: 443-842-7264
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: 800-786-8015