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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

General Provider Information

NPI Number	:	1205158110
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAN-DI-KI LLC

Provider Business Mailing Address
First Line	:	930 RIDGEBROOK RD FL 3
Second Line	:
City	:	SPARKS GLENCOE
State	:	MD
Zip	:	21152-9481
Country	:	US
Telephone Number	:	443-662-4101
Fax Number	:

Provider Business Practice Location Address
First Line	:	2502 E UNIVERSITY DR STE 290
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85034-6932
Country	:	US
Telephone Number	:	800-786-8015
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. BRIAN CUOMO
Credential	:
Telephone Number	:	443-662-4101

Provider Enumeration Date	:	02/18/2010
Last Update Date	:	02/26/2025

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