Physician Compare National (NPI:1407928039)

HEALTHCARE PROVIDER: JERRY KIYOSHIGE IZU M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1407928039
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	2163593930
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110602000487
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	IZU
	Individual professional last name
Provider First Name	JERRY
	Individual professional first name
Provider Middle Name	K
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIFORMED SERVICES UHS FE HEBERT SCHOOL OF MED
	Individual professional's medical school
Graduation Year	2000
	Individual professional's medical school graduation year
Primary Specialty	OBSTETRICS/GYNECOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	27871 SMYTH DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 102
	Group Practice or individual's line 2 address
City	VALENCIA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	913556062
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050624
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HENRY MAYO NEWHALL HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y