# SUNSET FAMILY PRACTICE GROUP PC

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

## Provider details

- **NPI number:** 1568408680
- **Authorized official:** MR. VIC KRISCIUNAS MD (LEAD PHYSICIAN)
- **Authorized official phone:** (503) 626-0939

## Contact information

- **Practice address:** 12400 NW CORNELL RD, PORTLAND, OR 97229-5616
- **Practice address phone:** (503) 626-0939
- **Practice address fax:** (503) 626-6161
- **Mailing address:** 12400 NW CORNELL RD, P.O. BOX 2767, PORTLAND, OR 97229-5616
- **Mailing address phone:** (503) 626-0939
- **Mailing address fax:** (503) 626-6161

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 06/20/2006
- **Last updated:** 07/27/2010