Provider Demographics
NPI:1902118961
Name:BAUCUM, DORIAN CHRISTIAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:DORIAN
Middle Name:CHRISTIAN
Last Name:BAUCUM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:DORIAN
Other - Middle Name:CHRISTIAN
Other - Last Name:BAUCUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:5575 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3808
Mailing Address - Country:US
Mailing Address - Phone:323-954-7193
Mailing Address - Fax:
Practice Address - Street 1:5575 WILSHIRE BOULEVARD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036
Practice Address - Country:US
Practice Address - Phone:323-954-7193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist