NPIMap

Organization Active NPI

Khakwani Medical Corporation, PC

Doing business as PDS Medical Group Green Valley

  • Family Medicine Physician
  • Henderson, NV
National Provider Identifier
1073341079
Registry record updated Mar 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KHAKWANI MEDICAL CORPORATION, PC
Doing business as
PDS Medical Group Green Valley
Practice address
2231B N Green Valley Pkwy
Henderson, NV 89014-5024
Phone
(702) 766-1972
Fax
(702) 844-7129
NPI assigned
Jul 23, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Valerie Denise Estrada
Title
Credentialing Manager
Phone
(469) 718-2768

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2231B N Green Valley Pkwy
Henderson, NV 89014-5024

Mailing address

PO Box 660048
Dallas, TX 75266-2901
Phone (702) 820-5713

Other names 1

  • PDS Medical Group Green Valley Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170725002901 NV Part B Supplier - Clinic/Group Practice 7214207141 Receives reassigned benefits from 13 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: North Las Vegas, NV; Las Vegas, NV; Henderson, NV

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Khakwani Medical Corporation PC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1135 Vitality Dr
Ste 120
Henderson, NV 89011
Phone (702) 359-7403

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1073341079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 660048",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752662901",
            "telephone_number": "702-820-5713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2231B N GREEN VALLEY PKWY",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890145024",
            "telephone_number": "702-766-1972",
            "fax_number": "702-844-7129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHAKWANI MEDICAL CORPORATION, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-23",
        "last_updated": "2025-03-26",
        "certification_date": "2025-03-26",
        "status": "A",
        "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"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDS Medical Group Green Valley",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PDS Medical Group Green Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.