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	45D2028785	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01099732	OTHER	TX	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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568744886
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	:	3418 MIDCOURT RD STE 105
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75006-4944
Country	:	US
Telephone Number	:	972-468-3581
Fax Number	:	443-842-7264

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL/CFO
Name	:	BRIAN C CUOMO
Credential	:
Telephone Number	:	7-868-0158

Provider Enumeration Date	:	09/13/2011
Last Update Date	:	03/11/2026

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Directions to “KAN DI KI, LLC ” Practice Location

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