Provider Demographics
NPI:1306006655
Name:A-ONE MEDICAL GROUP, INC. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:A-ONE MEDICAL GROUP, INC. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-965-1988
Mailing Address - Street 1:2705 S DIAMOND BAR BLVD
Mailing Address - Street 2:UNIT #100
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-3512
Mailing Address - Country:US
Mailing Address - Phone:626-965-1988
Mailing Address - Fax:626-236-9394
Practice Address - Street 1:2705 S DIAMOND BAR BLVD
Practice Address - Street 2:UNIT #100
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-3512
Practice Address - Country:US
Practice Address - Phone:626-965-1988
Practice Address - Fax:626-236-9394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty