Healthcare Provider Details

I. General information

NPI: 1497786883
Provider Name (Legal Business Name): APOLLO MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SUTTER ST SUITE 200
SAN FRANCISCO CA
94104-4002
US

IV. Provider business mailing address

110 SUTTER ST SUITE 200
SAN FRANCISCO CA
94104-4002
US

V. Phone/Fax

Practice location:
  • Phone: 415-291-0480
  • Fax: 415-291-0489
Mailing address:
  • Phone: 415-291-0480
  • Fax: 415-291-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA637651
License Number StateCA

VIII. Authorized Official

Name: THOMAS H. LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 415-291-0480