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General NPI Number Information
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NPI Number | 1053688036
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Entity Type | Organization
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Legal Business Name | SUNSET SURGICAL CENTRE LLC
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Dates
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Enumeration Date | 11/19/2011
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Last Update Date | 11/19/2011
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Provider Practice Location Address
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Address Line | 9555 SW BARNES RD SUITE 275
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City | PORTLAND
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State | OR
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Zip | 97225-6663
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Country | US
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Telephone | 503-297-8555
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Fax |
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Provider Business Mailing Address
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Address Line | 15390 NW CORNELL RD
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City | BEAVERTON
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State | OR
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Zip | 97006
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Country | US
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Telephone | 503-297-8555
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. KIM CHI VU
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Credential | MD
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Telephone | 509-297-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 60011591
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License Number State | OR
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