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
2	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
3	291U00000X	Clinical Medical Laboratory	205582	CA
4	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier	043518	CA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	05D0679751	OTHER	CA	CLIA NUMBER
11	05D2230383	OTHER	CA	CLIA

General Provider Information

NPI Number	:	1750364345
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	:	12612 RAYMER ST
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91605-4307
Country	:	US
Telephone Number	:	818-549-1880
Fax Number	:

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

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	03/11/2026

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

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