Provider Demographics
NPI:1316944861
Name:IZUMI, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:IZUMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 SCENIC AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626
Mailing Address - Country:US
Mailing Address - Phone:714-436-4444
Mailing Address - Fax:714-436-4812
Practice Address - Street 1:1665 SCENIC AVE
Practice Address - Street 2:STE 100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626
Practice Address - Country:US
Practice Address - Phone:714-436-4444
Practice Address - Fax:714-436-4812
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47882207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G478820OtherMEDI CAL
CAF52363Medicare UPIN