NPIMap

Organization Active NPI

Khakwani Medical Corporation, PC

Doing business as PDS Medical Group Henderson

  • Family Medicine Physician
  • Henderson, NV
National Provider Identifier
1801304043
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 Henderson
Practice address
366 W Lake Mead Pkwy Ste 100
Henderson, NV 89015-7287
Phone
(702) 359-5210
Fax
(702) 997-0475
NPI assigned
Jan 22, 2018
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 Physician 207Q00000X NU Primary

Addresses

Primary practice location

366 W Lake Mead Pkwy Ste 100
Henderson, NV 89015-7287

Mailing address

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

Other names 1

  • PDS Medical Group Henderson 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
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
29D2143210PDS Medical Group Henderson366 W Lake Mead Pkwy, Suite 100, Henderson, NV 89015Certificate of waiverJan 24, 2028

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

366 W Lake Mead Pkwy
Ste 140
Henderson, NV 89015

4950 W Sahara Ave
Ste 100B
Las Vegas, NV 89146
Phone (702) 577-9773

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1516579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742947200000",
    "number": "1801304043",
    "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": "366 W LAKE MEAD PKWY STE 100",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890157287",
            "telephone_number": "702-359-5210",
            "fax_number": "702-997-0475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KHAKWANI MEDICAL CORPORATION, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-22",
        "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": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PDS Medical Group Henderson",
            "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.
  • 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.