NPIMap

Organization Active NPI

Khakwani Medical Corporation, PC

Doing business as PDS Medical Group Queensridge

  • Family Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1134847965
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 Queensridge
Practice address
10040 Alta Dr Ste 110
Las Vegas, NV 89145
Phone
(702) 960-0689
Fax
(702) 960-1561
NPI assigned
Aug 18, 2022
Last updated
Mar 26, 2025By the provider in NPPES
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: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

10040 Alta Dr Ste 110
Las Vegas, NV 89145

Mailing address

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

Other names 1

  • PDS Medical Group Queensridge 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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2269108PDS Medical Group Queensridge10040 Alta Dr, Ste 100B, Las Vegas, NV 89145Certificate of waiverSep 20, 2026

National Provider Directory

National Provider Directory
Tax ID family
Khakwani Medical Corporation PC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

10040 Alta Dr
Ste 110
Las Vegas, NV 89145
Phone (702) 960-0689

6975 Aliante Pkwy
Ste 101B
North Las Vegas, NV 89084
Phone (702) 867-0087

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1660780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1134847965",
    "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",
            "fax_number": "702-820-5713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10040 ALTA DR STE 110",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89145",
            "telephone_number": "702-960-0689",
            "fax_number": "702-960-1561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHAKWANI MEDICAL CORPORATION, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-18",
        "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": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDS Medical Group Queensridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.