Provider Demographics
NPI:1093697757
Name:KAN-DI-KI, LLC
Entity type:Organization
Organization Name:KAN-DI-KI, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUOMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-786-8015
Mailing Address - Street 1:930 RIDGEBROOK RD FL 3
Mailing Address - Street 2:
Mailing Address - City:SPARKS GLENCOE
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9481
Mailing Address - Country:US
Mailing Address - Phone:443-662-4101
Mailing Address - Fax:602-343-5856
Practice Address - Street 1:175 TECHNOLOGY DR STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2473
Practice Address - Country:US
Practice Address - Phone:657-297-0320
Practice Address - Fax:602-343-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory