Basic Information
| Provider Information | |||||||||
| NPI: | 1841475019 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KHIN | ||||||||
| FirstName: | LAY | ||||||||
| MiddleName: | LAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43839 15TH ST W | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935344756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619455984 | ||||||||
| FaxNumber: | 6619513355 | ||||||||
| Practice Location | |||||||||
| Address1: | HIGH DESERT MEDICAL CORP | ||||||||
| Address2: | 43839 15TH ST WEST | ||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935344756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619455984 | ||||||||
| FaxNumber: | 6619513355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2008 | ||||||||
| LastUpdateDate: | 01/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME107065 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0022003-00 | 05 | FL | MEDICAID |