Provider Demographics
NPI:1871160572
Name:KANDI, KAVEH
Entity type:Individual
Prefix:
First Name:KAVEH
Middle Name:
Last Name:KANDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 DEMPSTER ST STE 502
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-8429
Mailing Address - Country:US
Mailing Address - Phone:224-217-5400
Mailing Address - Fax:224-217-5405
Practice Address - Street 1:2604 DEMPSTER ST STE 502
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-8429
Practice Address - Country:US
Practice Address - Phone:224-217-5400
Practice Address - Fax:224-217-5405
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.033137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist