Provider Demographics
NPI:1710040977
Name:IIZUKA, KATSUYA ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:KATSUYA
Middle Name:ANDREW
Last Name:IIZUKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:602 KAILUA RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2841
Mailing Address - Country:US
Mailing Address - Phone:808-263-9100
Mailing Address - Fax:808-263-9120
Practice Address - Street 1:602 KAILUA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2841
Practice Address - Country:US
Practice Address - Phone:808-263-9100
Practice Address - Fax:808-263-9120
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-16520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine