Ethan Ezaki

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

28643 Issued in CA

Practice address

11601 Wilshire Blvd
Los Angeles, CA 90025-0509

Phone

(310) 914-4118

Fax

(310) 914-4119

NPI assigned

Jul 28, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2003

Medicare assignment

May accept Medicare assignment

Group practices

Khodabakhshian Chiropractic IncGroup PAC ID 5294824082, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Khodabakhshian Chiropractic Inc

  dba Omega Solutions in Rehabilition

  • Chiropractor
  • Thousand Oaks, CA
  • NPI 1366521106
  Medicare reassignment Care Compare group NPD
• Westlake Sports Physical Therapy Inc

  • Orthopedic Physical Therapist
  • Westlake Village, CA
  • NPI 1023153236
  Medicare reassignment
• Physiotherapy Associates Inc

  dba Select Physical Therapy

  • Physical Therapy Clinic/Center
  • Estero, FL
  • NPI 1720039902
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1841204484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11601 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900250509",
            "telephone_number": "310-914-4118",
            "fax_number": "310-914-4119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11601 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900250509",
            "telephone_number": "310-914-4118",
            "fax_number": "310-914-4119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZAKI",
        "first_name": "ETHAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "28643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "28643",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Vaughn Aram Eyvazian, M.D.
• Ez Diagnosis Center LLC
• Ez Diagnostic Imaging Services, LLC
• Ez Speech Therapy, P.C.
• Amy Ezaki
• Eze Elitaire LLC
• Eze Mobile Phlebotomy Services LLC
• Eze Optimal Health Collective LLC
• Cordelia O Eze, BS
• James O Eze, MPA

• Physical Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.