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

Mr. Jack G. Fuller, PA-C

Individual provider Physician Assistant · NPI 1376596668

Mr. Jack G. Fuller, PA-C is a Physician Assistant in Los Angeles, California. Licensed in California. Registered with an NPI since 2006.

Licensed in
CA
In the registry since
2006
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

1225 Wilshire Blvd
Los Angeles, CA 90017-2395
Phone: (213) 977-2423
Fax: (213) 202-7028
Show map & directions

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA12536 (CA)

Record details

NPI number1376596668
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 18, 2006
Last updated in NPPESJuly 9, 2007

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