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MR. JACK G. FULLER PA-C
NPI 1376596668
Physician Assistant in Los Angeles, CA

Active since May 18, 2006
1225 WILSHIRE BOULEVARD, LOS ANGELES, CA 90017(213) 977-2423(213) 202-7028 Get Directions Write a Review

NPPES record last updated: July 9, 2007. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Jack G. Fuller Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JACK G. FULLER PA-C (NPI 1376596668) is an individual physician assistant in Los Angeles, California, licensed in California (PA12536) and active in the NPI registry since May 2006.

NPPES Registry Identity

NPI1376596668
Entity TypeIndividualMale
Primary Taxonomy363A00000X
Provider Legal NameMR. JACK G. FULLERCredential: PA-C
Location Address1225 WILSHIRE BOULEVARDLos Angeles, CA 90017-2395
Mailing Address2550 Northhollywood Way, Suite 209Burbank, CA 91505-5019 · (818) 557-0135 · Fax (818) 557-1394
Phone(213) 977-2423
Fax(213) 202-7028
Sole ProprietorNo
Enumeration DateMay 18, 2006
Last NPPES UpdateJuly 9, 2007
✔ NPI 1376596668 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in CA · PA12536
Definition
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.
1225 WILSHIRE BOULEVARD, Los Angeles, CA 90017
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Other Identifiers 4

Medicare OSCAR/certificationWPA12536ACA
OtherP00198638CA · Good Samaritan Railroad
Medicare UPINA12592CA
MedicaidPA12536CA

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KRISTINA L. STILWELL PA-C
Physician Assistant
1225 WILSHIRE BOULEVARD
LOS ANGELES, CA 90017
Los Angeles County (213) 977-2423
DR. ROBERT F. KERNS M.D.
Emergency Medicine
1225 WILSHIRE BOULEVARD
LOS ANGELES, CA 90017
Los Angeles County (213) 977-2423
DR. JOHN A. HATHERLEY M.D.
Emergency Medicine
1225 WILSHIRE BOULEVARD
LOS ANGELES, CA 90017
Los Angeles County (213) 977-2423
DR. BRIAN W. HARRIS M.D.
Emergency Medicine
1225 WILSHIRE BOULEVARD
LOS ANGELES, CA 90017
Los Angeles County (213) 977-2423
DR. RONALD E. LIEBERMAN M.D.
Emergency Medicine
1225 WILSHIRE BOULEVARD
LOS ANGELES, CA 90017
Los Angeles County (213) 977-2423
DR. NANCY J. KUHN M.D.
Emergency Medicine
1225 WILSHIRE BOULEVARD
LOS ANGELES, CA 90017
Los Angeles County (213) 977-2423
FAGAN ER MEDICAL GROUP INC
Internal Medicine
1225 WILSHIRE BOULEVARD
LOS ANGELES, CA 90017
Los Angeles County (213) 482-2741
EMERGENCY DEPARTMENT PHYSICIANS MEDICAL GROUP, INC.
Emergency Medicine
1225 WILSHIRE BOULEVARD
LOS ANGELES, CA 90017
Los Angeles County (213) 482-2741

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Fuller's NPI number?

The NPI number for Jack Fuller is 1376596668. It was assigned to this individual provider in the NPPES registry on May 18, 2006.

Where is Jack Fuller located?

Jack Fuller practices at 1225 Wilshire Boulevard, Los Angeles, CA 90017. The listed phone number is (213) 977-2423.

What is Jack Fuller's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

When was this NPI record last updated?

The NPPES record for Jack Fuller was last updated on July 9, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.