Provider Demographics
NPI:1073726683
Name:FKS ENTERPRISE INC
Entity Type:Organization
Organization Name:FKS ENTERPRISE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FARIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAN-SEWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-655-1400
Mailing Address - Street 1:2809 CRYSTAL BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-6908
Mailing Address - Country:US
Mailing Address - Phone:702-686-8977
Mailing Address - Fax:702-685-0612
Practice Address - Street 1:2600 S RAINBOW BLVD
Practice Address - Street 2:#108
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-4006
Practice Address - Country:US
Practice Address - Phone:702-655-1400
Practice Address - Fax:702-685-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9753207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100507762Medicaid
NV100507762Medicaid