# ADVANCED MD MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780128256
- **Authorized official:** MR. DIRK KANCILIA (ADMINISTRATION)
- **Authorized official phone:** (858) 345-4887

## Contact information

- **Practice address:** 2878 CAMINO DEL RIO S STE 404, SAN DIEGO, CA 92108-3848
- **Practice address phone:** (858) 345-4887
- **Mailing address:** 235 W WASHINGTON AVE, A55, ESCONDIDO, CA 92025-2634
- **Mailing address phone:** (858) 345-4887

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | G87969 | CA | Yes |

## Other

- **Enumeration date:** 12/18/2016
- **Last updated:** 12/18/2016