Provider Demographics
NPI:1265744957
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: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 1:3586 S 500 W
Practice Address - Street 2:
Practice Address - City:S SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-4236
Practice Address - Country:US
Practice Address - Phone:801-263-2159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-09
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1265744957Medicaid
UTP01005667OtherRAILROAD MEDICARE
U000073103Medicare PIN