MR. JACK G. FULLER (NPI# 1376596668) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376596668 |
| Entity Type | Individual |
| Full Name | MR. JACK G. FULLER |
| Credential | PA-C |
| Practice Address |
1225 Wilshire Boulevard Los Angeles CA 90017-2395 |
| Mailing Address |
2550 Northhollywood Way Suite 209 Burbank CA 91505-5019 |
| Practice Telephone | 2139772423 |
| Practice Fax Number | 2132027028 |
| Mailing Telephone | 8185570135 |
| Mailing Fax Number | 8185571394 |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2007-07-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA12536 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GOOD SAMARITAN RAILROAD | P00198638 | 01 |
| CA | PA12536 | 05 |
| Street Address |
1225 WILSHIRE BOULEVARD |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90017-2395 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316122104 | Sung Im | Anesthesiology | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2007-12-31 |
| 1952477499 | Robert A Kloner | Specialist | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-11-27 |
| 1730104498 | Emergency Department Physicians Medical Group, Inc. | Emergency Medicine | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-07-13 |
| 1588689236 | Fagan Er Medical Group Inc | Internal Medicine | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-07-13 |
| 1922049295 | Melvin L Jackson | Emergency Medicine | 1225 Wilshire Boulevard, Good Samaritan Hospital, Los Angeles, CA 90017-2395 | 2006-06-09 |
| 1427004621 | Ronald E. Lieberman | Emergency Medicine | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-05-26 |
| 1114972726 | Kristina L. Stilwell | Physician Assistant | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-05-23 |
| 1144274168 | Robert F. Kerns | Emergency Medicine | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-05-22 |
| 1457305344 | Nancy J. Kuhn | Emergency Medicine | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-05-22 |
| 1164476883 | John A. Hatherley | Emergency Medicine | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-05-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144833617 | Guadalupe Vallejo | Licensed Vocational Nurse | 515 Columbia Avenue, #200, 515 Columbia Avenue, Los Angeles, CA 90017 | 2020-08-25 |
| 1376181768 | Nirlok Corporation | Optometrist | 750 West 7th Street, Los Angeles, CA 90017 | 2019-12-16 |
| 1689228223 | Marycarmen Beltran | Student in an Organized Health Care Education/Training Program | 333 S. Beaudry Ave., Los Angeles, CA 90017 | 2019-08-01 |
| 1639661465 | Robin B Horowitz | Counselor | 333 South Beaudry Avenue, Los Angeles, CA 90017 | 2018-06-06 |
| 1710483797 | Rose Jadidian | Pharmacist | 701 S. Flower, Ste. 3150, Los Angeles, CA 90017 | 2018-03-30 |
| 1417469875 | Marykarla Gallegos | Case Manager/Care Coordinator | 1125 W. 6th St., Suite 103, Los Angeles, CA 90017 | 2017-10-25 |
| 1134646516 | Maria Salas | Rehabilitation Practitioner | 333 S Beaudry Ave., Los Angeles, CA 90017 | 2017-08-25 |
| 1932638202 | Butterfli Technologies Inc | Transportation Broker | 865 S Figueroa St Ste 2750, Los Angeles, CA 90017 | 2017-06-08 |
| 1316493125 | Phamily Love Foundation | Community/Behavioral Health | 626 Wilshire Blvd ., Suite 910, Los Angeles, CA 90017 | 2016-08-31 |
| 1215392188 | Jessica R. Garcia-hillard | Specialist/Technologist | 1111 W. 6th St., Suite 111, Los Angeles, CA 90017 | 2015-12-21 |
| Find all providers in zip 90017 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154929644 | Tatum Little | Physician Assistant | 3307 W 79th St, Los Angeles, CA 90043-5249 | 2020-10-15 |
| 1144828963 | Chan Ho Park | Physician Assistant | 4721 Oakwood Ave, Los Angeles, CA 90004-3112 | 2020-10-14 |
| 1235737172 | Jennifer Rae Levitt Physician Assistant, Inc | Physician Assistant | 1439 N Highland Ave Ste 1059, Los Angeles, CA 90028-7622 | 2020-10-13 |
| 1174120943 | Melody Fatehi | Physician Assistant | 6228 Orange St Apt 9, Los Angeles, CA 90048-4836 | 2020-10-05 |
| 1467063826 | Hannah Shannon Rihani | Physician Assistant | 1737 Midvale Ave, Los Angeles, CA 90024-5512 | 2020-08-11 |
| 1356969901 | Emily Rachel Lavi | Physician Assistant | 1132 S Holt Ave Apt 7, Los Angeles, CA 90035-2424 | 2020-07-09 |
| 1083242952 | Julia Andrea Hurtado | Physician Assistant | 3783 Cimarron St, Los Angeles, CA 90018-4463 | 2020-03-27 |
| 1174150130 | Susan C. Williams | Physician Assistant | 2215 Alcazar St, Los Angeles, CA 90033-1003 | 2020-03-26 |
| 1720615776 | Shannon Hakakeyan | Physician Assistant | 1580 Manning Ave Apt 303, Los Angeles, CA 90024-6086 | 2020-03-26 |
| 1952938243 | Jayanti Sharma | Physician Assistant | 1515 Amherst Ave Apt 303, Los Angeles, CA 90025-3677 | 2020-03-25 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90017 |
Please comment or provide details below to improve the information on MR. JACK G. FULLER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.