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	03D2024612	AZ
2	291U00000X	Clinical Medical Laboratory

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01126484	OTHER	AZ	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
2	03D2024612	OTHER	AZ	CLIA

General Provider Information

NPI Number	:	1417241365
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	:	3230 E. BROADWAY ROAD
Second Line	:	SUITE 100
City	:	PHOENIX
State	:	AZ
Zip	:	85040-2874
Country	:	US
Telephone Number	:	480-967-2281
Fax Number	:	480-967-0306

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

Provider Enumeration Date	:	06/07/2011
Last Update Date	:	01/26/2017

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

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