Provider Demographics
NPI:1851625586
Name:ONE MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:ONE MEDICAL GROUP, P.C.
Other - Org Name:ONE MEDICA GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:HO
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-658-6791
Mailing Address - Street 1:PO BOX 26170
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94126-6170
Mailing Address - Country:US
Mailing Address - Phone:415-814-0927
Mailing Address - Fax:415-354-3430
Practice Address - Street 1:489 FIFTH AVE.
Practice Address - Street 2:3RD FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6109
Practice Address - Country:US
Practice Address - Phone:212-530-2288
Practice Address - Fax:212-867-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty