Provider Demographics
NPI:1891674305
Name:GANDOM LLC
Entity type:Organization
Organization Name:GANDOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHAJA HUMAYOUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-621-6788
Mailing Address - Street 1:4225 E MEXICO AVE APT 603
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4139
Mailing Address - Country:US
Mailing Address - Phone:609-621-6788
Mailing Address - Fax:
Practice Address - Street 1:1785 QUEBEC ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1900
Practice Address - Country:US
Practice Address - Phone:609-621-6788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals