MEDICARE: ONE MEDICAL GROUP OF WASHINGTON, P.C.

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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1598214397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE MEDICAL GROUP OF WASHINGTON, P.C.

Provider Business Mailing Address
First Line	:	130 SUTTER ST FL 2
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94104-4009
Country	:	US
Telephone Number	:	415-658-6791
Fax Number	:	415-520-0904

Provider Business Practice Location Address
First Line	:	1600 7TH AVE STE 110
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98101-2284
Country	:	US
Telephone Number	:	415-658-6791
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS HO LEE
Credential	:	M.D.
Telephone Number	:	415-658-6791

Provider Enumeration Date	:	09/22/2016
Last Update Date	:	09/22/2016

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