Organization
SUNSET FAMILY PRACTICE GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VIC KRISCIUNAS MD (LEAD PHYSICIAN)
(503) 626-0939
Entity
Organization
Contact information
Practice address
12400 NW CORNELL RD, PORTLAND, OR 97229-5616
(503) 626-0939
(503) 626-6161
Mailing address
12400 NW CORNELL RD, P.O. BOX 2767, PORTLAND, OR 97229-5616
(503) 626-0939
(503) 626-6161
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11896
PTAN
OR
01
—
141978
PTAN
OR
01
—
1437190741
NPI
OR
01
—
1508809781
NPI
OR
01
—
1841236924
NPI
OR
01
—
1891736104
NPI
OR
01
—
1912014317
NPI
OR
01
—
38D0621672
CLIA
—
01
—
DOWCQKWB
PTAN
OR
01
—
DOWCQKWC
PTAN
OR
01
—
R00WCQKWD
PTAN
OR
Enumeration date
06/20/2006
Last updated
07/27/2010
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