MEDICARE: KHAKWANI MEDICAL CORPORATION, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1407517436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KHAKWANI MEDICAL CORPORATION, PC

Provider Business Mailing Address
First Line	:	PO BOX 660048
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-2901
Country	:	US
Telephone Number	:	702-820-5713
Fax Number	:	702-820-5713

Provider Business Practice Location Address
First Line	:	4950 W SAHARA AVE STE 100B
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146
Country	:	US
Telephone Number	:	702-577-9773
Fax Number	:	702-577-3260

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	VALERIE DENISE ESTRADA
Credential	:
Telephone Number	:	469-718-2768

Provider Enumeration Date	:	01/03/2022
Last Update Date	:	03/26/2025

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