Organization
KAN-DI-KI LLC
Active
Other names
Diagnostic Laboratories, TridentCare
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN C CUOMO (AUTHORIZED OFFICIAL/CFO)
(800) 786-8015
Entity
Organization
Contact information
Practice address
12612 RAYMER ST, NORTH HOLLYWOOD, CA 91605-4307
(818) 549-1880
Mailing address
215 SCHILLING CIR STE 114, HUNT VALLEY, MD 21031-1113
(800) 786-8015
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
205582
CA
291U00000X
Clinical Medical Laboratory
—
—
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
043518
CA
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0679751
CLIA NUMBER
CA
01
—
05D2230383
CLIA
CA
05
—
1750364345
—
MN
05
—
2041261
—
WA
05
—
2443518
—
LA
05
—
414224201
—
TX
05
—
500621162
—
OR
05
—
LAB79751F
—
CA
05
—
XR059811F
—
CA
05
—
ZZZ31268Z
—
CA
05
—
ZZZ59811Z
—
CA
Enumeration date
11/28/2005
Last updated
03/11/2026
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