Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack Theodore Ezzedine

Individual provider Medical Physician Assistant · NPI 1053137513

Jack Theodore Ezzedine is a Medical Physician Assistant in Alhambra, California. Practices as a sole proprietor. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

1000 S Fremont Ave
Alhambra, CA 91803-8800
Phone: (626) 457-4240
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X

Record details

NPI number1053137513
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedDecember 2, 2024
Last updated in NPPESDecember 2, 2024
Certification dateDecember 1, 2024
Mailing address678 E Walnut St Unit 311, Pasadena, CA 91101-2283

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