Provider Demographics
NPI:1073341079
Name:KHAKWANI MEDICAL CORPORATION, PC
Entity type:Organization
Organization Name:KHAKWANI MEDICAL CORPORATION, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-718-2768
Mailing Address - Street 1:PO BOX 660048
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-2901
Mailing Address - Country:US
Mailing Address - Phone:702-820-5713
Mailing Address - Fax:
Practice Address - Street 1:2231B N GREEN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-5024
Practice Address - Country:US
Practice Address - Phone:702-766-1972
Practice Address - Fax:702-844-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-23
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty