MEDICARE: KANIKA SHANTA CANNON

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	104100000X	Social Worker		CA

General Provider Information

NPI Number	:	1689506990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANIKA SHANTA CANNON

Provider Business Mailing Address
First Line	:	9849 SALLY AVE
Second Line	:
City	:	CALIFORNIA CITY
State	:	CA
Zip	:	93505-1346
Country	:	US
Telephone Number	:	213-264-8655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 W AVENUE K STE 105
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-6422
Country	:	US
Telephone Number	:	213-264-8655
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ KANIKA SHANTA CANNON ” Practice Location

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