Basic Information
| Provider Information | |||||||||
| NPI: | 1518977511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MYINT | ||||||||
| FirstName: | KHAING | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7007 | ||||||||
| Address2: | HIGH DESERT MEDICAL GROUP | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935397007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619455984 | ||||||||
| FaxNumber: | 6612729107 | ||||||||
| Practice Location | |||||||||
| Address1: | 2260 E PALMDALE BLVD | ||||||||
| Address2: | HERITAGE HEALTHCARE MEDICAL GROUP | ||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935504952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612723777 | ||||||||
| FaxNumber: | 6612729107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 09/10/2007 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 08/11/2006 | ||||||||
| NPIReactivationDate: | 09/15/2006 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A71721 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A717210 | 05 | CA | MEDICAID |