Healthcare Provider Details

I. General information

NPI: 1124340039
Provider Name (Legal Business Name): KAN-DI-KI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 INDUSTRY DR
TUKWILA WA
98188-4803
US

IV. Provider business mailing address

930 RIDGEBROOK RD
SPARKS MD
21152-9481
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-1612
  • Fax: 253-815-8851
Mailing address:
  • Phone: 800-786-8015
  • Fax:

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