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
1	P01099718	OTHER	NV	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1700198330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAN-DI-KI LLC

Provider Business Mailing Address
First Line	:	930 RIDGEBROOK RD
Second Line	:
City	:	SPARKS
State	:	MD
Zip	:	21152-9481
Country	:	US
Telephone Number	:	800-786-8015
Fax Number	:

Provider Business Practice Location Address
First Line	:	7355 PRAIRIE FALCON RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0801
Country	:	US
Telephone Number	:	702-589-9795
Fax Number	:	443-842-7264

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL/CFO
Name	:	BRIAN C CUOMO
Credential	:
Telephone Number	:	800-786-8015

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	02/08/2024

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

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