Provider Demographics
NPI:1497786883
Name:APOLLO MEDICAL GROUP
Entity Type:Organization
Organization Name:APOLLO MEDICAL GROUP
Other - Org Name:METROPOLITAN MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-291-0480
Mailing Address - Street 1:110 SUTTER ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4002
Mailing Address - Country:US
Mailing Address - Phone:415-291-0480
Mailing Address - Fax:415-291-0489
Practice Address - Street 1:110 SUTTER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4002
Practice Address - Country:US
Practice Address - Phone:415-291-0480
Practice Address - Fax:415-291-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA637651173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherGROUP TAX ID #
CAX81287Medicare UPIN
CA=========OtherGROUP TAX ID #