Provider Demographics
NPI:1407928039
Name:IZU, JERRY KIYOSHIGE (MD)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:KIYOSHIGE
Last Name:IZU
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23206 LYONS AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2671
Mailing Address - Country:US
Mailing Address - Phone:661-516-2955
Mailing Address - Fax:661-516-2913
Practice Address - Street 1:23206 LYONS AVE STE 112
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2671
Practice Address - Country:US
Practice Address - Phone:661-516-2955
Practice Address - Fax:661-516-2913
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53579207V00000X, 207V00000X
HIMD-11850207V00000X
ND11249207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology