Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 21573 | TX |
NPI | 1164458238 |
---|---|
Provider Name | Dr. Kevin Hiroshi Izu |
First Address | Houston, TX 77079-5047 |
Second Address | Houston, TX 77024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 08/07/2007 |