MEDICARE: KAN-DI-KI LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	5562LIC-4	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01138750	OTHER	NV	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073859930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAN-DI-KI LLC

Provider Business Mailing Address
First Line	:	215 SCHILLING CIR STE 114
Second Line	:
City	:	HUNT VALLEY
State	:	MD
Zip	:	21031-1113
Country	:	US
Telephone Number	:	800-786-8015
Fax Number	:

Provider Business Practice Location Address
First Line	:	7355 PRAIRIE FALCON RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0801
Country	:	US
Telephone Number	:	702-982-0533
Fax Number	:	702-982-0991

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL/CFO
Name	:	BRIAN C CUOMO
Credential	:
Telephone Number	:	800-786-8015

Provider Enumeration Date	:	12/21/2012
Last Update Date	:	03/11/2026

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Directions to “KAN-DI-KI LLC ” Practice Location

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