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General NPI Number Information
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NPI Number | 1801304043
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Entity Type | Organization
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Legal Business Name | KHAKWANI MEDICAL CORPORATION, PC
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Dates
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Enumeration Date | 01/22/2018
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 366 W LAKE MEAD PKWY STE 100
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City | HENDERSON
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State | NV
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Zip | 89015-7287
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Country | US
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Telephone | 702-359-5210
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Fax | 702-997-0475
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Provider Business Mailing Address
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Address Line | PO BOX 660048
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City | DALLAS
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State | TX
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Zip | 75266-2901
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Country | US
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Telephone | 702-820-5713
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Fax | 702-820-5713
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | VALERIE DENISE ESTRADA
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Credential |
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Telephone | 469-718-2768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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