MEDICARE: MR. JERRY KIYOSHIGE IZU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	C53579	CA

General Provider Information

NPI Number	:	1407928039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERRY KIYOSHIGE IZU M.D.

Provider Business Mailing Address
First Line	:	23206 LYONS AVE STE 112
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-2671
Country	:	US
Telephone Number	:	661-516-2955
Fax Number	:	661-516-2913

Provider Business Practice Location Address
First Line	:	23206 LYONS AVE STE 112
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91321-2671
Country	:	US
Telephone Number	:	661-516-2955
Fax Number	:	661-516-2913

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	03/31/2025

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