Provider Demographics
NPI:1578084547
Name:RAUCHUT, KEVIN WILLIAM JR (NP-C)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WILLIAM
Last Name:RAUCHUT
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5901 W OLYMPIC BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-4664
Mailing Address - Country:US
Mailing Address - Phone:323-215-1725
Mailing Address - Fax:323-205-3867
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 310
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4664
Practice Address - Country:US
Practice Address - Phone:323-215-1725
Practice Address - Fax:323-205-3867
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95006830363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology