Provider Demographics
NPI:1700468204
Name:KHAKWANI MEDICAL CORPORATION, PC
Entity Type:Organization
Organization Name:KHAKWANI MEDICAL CORPORATION, PC
Other - Org Name:UNION VILLAGE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HARRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KHAKWANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-820-5713
Mailing Address - Street 1:2460 PASEO VERDE PKWY STE 145
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7142
Mailing Address - Country:US
Mailing Address - Phone:702-820-5713
Mailing Address - Fax:702-820-5713
Practice Address - Street 1:1135 VITALITY DR STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89011
Practice Address - Country:US
Practice Address - Phone:702-359-7403
Practice Address - Fax:702-765-4748
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KHAKWANI MEDICAL CORPORATION, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-23
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty