1235851510 NPI number — KHAKWANI MEDICAL CORPORATION, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235851510 NPI number — KHAKWANI MEDICAL CORPORATION, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KHAKWANI MEDICAL CORPORATION, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235851510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6525 N DECATUR BLVD STE 150B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89131-2993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-979-5903
Provider Business Practice Location Address Fax Number:
702-984-7315
Provider Enumeration Date:
09/14/2022

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com