=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790945632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A-ONE MEDICAL GROUP, INC. A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/13/2008
-----------------------------------------------------
Last Update Date | 08/03/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2705 S DIAMOND BAR BLVD SUITE 118
-----------------------------------------------------
City | DIAMOND BAR
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91765-3512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-965-1988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5405 ALTON PKWY SUITE 5A-556
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92604-3717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-965-1988
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID P LEE
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 626-965-1988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20A7715
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------