Organization
KAN-DI-KI LLC
Active
Other names
Tridentcare, DIAGNOSTIC LABORATORIES
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN C CUOMO (AUTHORIZED OFFICIAL/CFO)
(800) 786-8015
Entity
Organization
Contact information
Practice address
17744 NE SAN RAFAEL ST, PORTLAND, OR 97230-5927
(800) 638-3240
(303) 576-7986
Mailing address
215 SCHILLING CIR STE 114, HUNT VALLEY, MD 21031-1113
(800) 786-8015
Taxonomy
Speciality
Code
Description
License number
State
2085U0001X
Diagnostic Ultrasound Physician
Primary
—
—
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500654573
—
OR
01
—
P01099725
RAILROAD MEDICARE
OR
Enumeration date
07/12/2010
Last updated
03/11/2026
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