1962798645 NPI number — ONE MEDICAL GROUP, P.C.

Table of content: (NPI 1962798645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962798645 NPI number — ONE MEDICAL GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE MEDICAL GROUP, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ONE MEDICAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962798645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 EMBARCADERO CTR STE 1900
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94111-3723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-658-6791
Provider Business Mailing Address Fax Number:
415-520-0904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1627 EYE ST NW
Provider Second Line Business Practice Location Address:
STE. 800
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20006-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-660-0015
Provider Business Practice Location Address Fax Number:
202-660-0025
Provider Enumeration Date:
06/22/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DIAMOND
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
415-658-6791

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD039185 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD039185 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)