Provider Demographics
NPI:1265870380
Name:JERRY IZU MEDICAL PC
Entity type:Organization
Organization Name:JERRY IZU MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:KIYOSHIGE
Authorized Official - Last Name:IZU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-516-2955
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-11
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty