Provider Demographics
NPI:1417241365
Name:KAN-DI-KI LLC
Entity Type:Organization
Organization Name:KAN-DI-KI LLC
Other - Org Name:DIAGNOSTIC LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:VELEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-940-0389
Mailing Address - Street 1:2820 N ONTARIO ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-2015
Mailing Address - Country:US
Mailing Address - Phone:818-549-1880
Mailing Address - Fax:818-333-7234
Practice Address - Street 1:3230 E. BROADWAY ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-2874
Practice Address - Country:US
Practice Address - Phone:480-967-2281
Practice Address - Fax:480-967-0306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ03D2024612291U00000X
291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ619775Medicaid
AZ03D2024612OtherCLIA
AZP01126484OtherRAILROAD MEDICARE
AZ03D2024612OtherCLIA