Advanced MD Medical Group Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

G87969 Issued in CA

Legal business name

ADVANCED MD MEDICAL GROUP INC

Practice address

2878 Camino del Rio S Ste 404
San Diego, CA 92108-3848

Phone

(858) 345-4887

NPI assigned

Dec 18, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dirk Kancilia

Title

Administration

Phone

(858) 345-4887

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1482019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1482019200000",
    "number": "1780128256",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 W WASHINGTON AVE",
            "address_2": "A55",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920252634",
            "telephone_number": "858-345-4887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2878 CAMINO DEL RIO S STE 404",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083848",
            "telephone_number": "858-345-4887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MD MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-18",
        "last_updated": "2016-12-18",
        "status": "A",
        "authorized_official_last_name": "KANCILIA",
        "authorized_official_first_name": "DIRK",
        "authorized_official_title_or_position": "ADMINISTRATION",
        "authorized_official_telephone_number": "858-345-4887",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "G87969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Advanced Family Counseling of San Diego Prof Corp
• Advanced Healthcare Center Apc
• Advanced Home Care Services LLC
• Advanced Home Health Care Inc
• Advanced Home Health San Diego Inc
• Advanced Pain Management & Anesthesiology
• Advanced Pediatric Medical Group Inc
• Advanced Rehabilitation Technologies
• Advanced Sleep Medicine Services Inc
• Advanced Sleep Medicine Services, Inc.

• General Practice Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.