Healthcare Provider Details

I. General information

NPI: 1720196702
Provider Name (Legal Business Name): HIGH DESERT MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 09/02/2025
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43839 15TH ST W
LANCASTER CA
93534-4756
US

IV. Provider business mailing address

PO BOX 7007
LANCASTER CA
93539-7007
US

V. Phone/Fax

Practice location:
  • Phone: 661-945-5984
  • Fax: 661-951-3192
Mailing address:
  • Phone: 661-945-5984
  • Fax: 661-951-3192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES MYAING LIM
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 661-945-5984