MEDICARE: APOLLO MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	A637651	CA

General Provider Information

NPI Number	:	1497786883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APOLLO MEDICAL GROUP

Provider Business Mailing Address
First Line	:	110 SUTTER ST
Second Line	:	SUITE 200
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-4002
Country	:	US
Telephone Number	:	415-291-0480
Fax Number	:	415-291-0489

Provider Business Practice Location Address
First Line	:	110 SUTTER ST
Second Line	:	SUITE 200
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-4002
Country	:	US
Telephone Number	:	415-291-0480
Fax Number	:	415-291-0489

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS H. LEE
Credential	:	MD
Telephone Number	:	415-291-0480

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/21/2022

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