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	2085U0001X	Diagnostic Ultrasound Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01005667	OTHER	UT	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	:	1265744957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAN-DI-KI LLC

Provider Business Mailing Address
First Line	:	2820 N ONTARIO ST
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91504-2015
Country	:	US
Telephone Number	:	818-549-1880
Fax Number	:	818-333-7234

Provider Business Practice Location Address
First Line	:	3586 S 500 W
Second Line	:
City	:	S SALT LAKE
State	:	UT
Zip	:	84115-4236
Country	:	US
Telephone Number	:	801-263-2159
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE VP
Name	:	MR. DAVID VELEZ
Credential	:
Telephone Number	:	800-940-0389

Provider Enumeration Date	:	07/09/2010
Last Update Date	:	02/28/2022

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

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