Healthcare Provider Details

I. General information

NPI: 1265870380
Provider Name (Legal Business Name): JERRY IZU MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2013
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23206 LYONS AVE STE 112
SANTA CLARITA CA
91321-2671
US

IV. Provider business mailing address

23206 LYONS AVE STE 112
SANTA CLARITA CA
91321-2671
US

V. Phone/Fax

Practice location:
  • Phone: 661-516-2955
  • Fax: 661-516-2913
Mailing address:
  • Phone: 661-516-2955
  • Fax: 661-516-2913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JERRY KIYOSHIGE IZU
Title or Position: OWNER
Credential: MD
Phone: 661-516-2955