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:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:27871 SMYTH DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-6061
Mailing Address - Country:US
Mailing Address - Phone:661-259-1781
Mailing Address - Fax:661-259-4571
Practice Address - Street 1:27871 SMYTH DR
Practice Address - Street 2:102
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-6061
Practice Address - Country:US
Practice Address - Phone:661-259-1781
Practice Address - Fax:661-259-4571
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53579207V00000X, 207V00000X
HIMD-11850207V00000X
ND11249207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology